Provider First Line Business Practice Location Address:
883 WORTHINGTON 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:
92114-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-339-2993
Provider Business Practice Location Address Fax Number:
619-303-9920
Provider Enumeration Date:
10/26/2009