Provider First Line Business Practice Location Address:
2496 E ST
Provider Second Line Business Practice Location Address:
#2F
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-723-9244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2007