Provider First Line Business Practice Location Address:
306 WALNUT AVE
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-4980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-295-4545
Provider Business Practice Location Address Fax Number:
619-295-6575
Provider Enumeration Date:
02/08/2012