Provider First Line Business Practice Location Address:
3605 ADAMS 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:
92116-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-284-1014
Provider Business Practice Location Address Fax Number:
619-284-4501
Provider Enumeration Date:
04/14/2009