Provider First Line Business Practice Location Address:
4178 ALABAMA ST
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-1081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-495-5564
Provider Business Practice Location Address Fax Number:
858-495-6301
Provider Enumeration Date:
03/07/2007