Provider First Line Business Practice Location Address:
3660 FAIRMOUNT 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:
92105-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-2250
Provider Business Practice Location Address Fax Number:
619-521-5944
Provider Enumeration Date:
11/09/2010