Provider First Line Business Practice Location Address:
909 CARDIFF ST
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:
92114-5019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-3121
Provider Business Practice Location Address Fax Number:
619-465-6708
Provider Enumeration Date:
09/25/2006