Provider First Line Business Practice Location Address:
4310 EUCLID AVE
Provider Second Line Business Practice Location Address:
SUITE D & E
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-584-4048
Provider Business Practice Location Address Fax Number:
619-280-3827
Provider Enumeration Date:
07/11/2006