Provider First Line Business Practice Location Address:
325 W. WASHINGTON ST. STE. 2, #117
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-518-4045
Provider Business Practice Location Address Fax Number:
619-923-0000
Provider Enumeration Date:
08/15/2008