Provider First Line Business Practice Location Address:
3526 7TH 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:
92103-5009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-499-3080
Provider Business Practice Location Address Fax Number:
858-499-4441
Provider Enumeration Date:
03/06/2007