Provider First Line Business Practice Location Address:
1753 GARNET 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:
92109-3351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-705-4269
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2013