Provider First Line Business Practice Location Address:
3520 3RD AVE
Provider Second Line Business Practice Location Address:
APT. 204
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-4933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-955-5153
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2014