Provider First Line Business Practice Location Address:
3288 ADAMS AVE
Provider Second Line Business Practice Location Address:
16290
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-888-6699
Provider Business Practice Location Address Fax Number:
858-726-6203
Provider Enumeration Date:
02/26/2007