Provider First Line Business Practice Location Address:
3659 INDIA ST
Provider Second Line Business Practice Location Address:
STE #100
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:
619-297-7722
Provider Business Practice Location Address Fax Number:
619-297-8076
Provider Enumeration Date:
12/28/2006