Provider First Line Business Practice Location Address:
5865 CUMBERLAND ST
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:
92139-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-470-3710
Provider Business Practice Location Address Fax Number:
619-470-3711
Provider Enumeration Date:
08/10/2006