Provider First Line Business Practice Location Address:
3065 ROSECRANS PL
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-4820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-740-7317
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2012