Provider First Line Business Practice Location Address:
2310 CRAVEN ST
Provider Second Line Business Practice Location Address:
NDMC 32ND ST. BLDG. 3230
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92136-5596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-556-1581
Provider Business Practice Location Address Fax Number:
619-556-9433
Provider Enumeration Date:
02/08/2007