Provider First Line Business Practice Location Address:
3177A OCEANVIEW BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
92113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-595-4454
Provider Business Practice Location Address Fax Number:
619-595-4455
Provider Enumeration Date:
04/06/2007