Provider First Line Business Practice Location Address:
3326 TRUMBULL 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:
92106-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-400-7972
Provider Business Practice Location Address Fax Number:
619-456-0011
Provider Enumeration Date:
12/19/2011