Provider First Line Business Practice Location Address:
4776 CASS ST
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:
92109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-270-1922
Provider Business Practice Location Address Fax Number:
858-270-0031
Provider Enumeration Date:
09/28/2006