Provider First Line Business Practice Location Address:
427 C ST STE 212
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:
92101-5121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-238-4180
Provider Business Practice Location Address Fax Number:
619-238-4245
Provider Enumeration Date:
12/28/2010