Provider First Line Business Practice Location Address:
1094 CUDAHY PL
Provider Second Line Business Practice Location Address:
SUITE 314/312
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-275-0822
Provider Business Practice Location Address Fax Number:
619-275-5069
Provider Enumeration Date:
01/19/2011