Provider First Line Business Practice Location Address:
1094 CUDAHY PL STE 314
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:
92110-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-276-8812
Provider Business Practice Location Address Fax Number:
619-276-8230
Provider Enumeration Date:
03/22/2011