Provider First Line Business Practice Location Address:
1568 6TH AVE
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:
92101-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-235-2600
Provider Business Practice Location Address Fax Number:
619-696-9573
Provider Enumeration Date:
11/27/2006