Provider First Line Business Practice Location Address:
4514 BANCROFT ST
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92116-4428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-727-0322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2014