Provider First Line Business Practice Location Address:
4135 54TH PL
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:
92105-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-825-5590
Provider Business Practice Location Address Fax Number:
619-741-7053
Provider Enumeration Date:
04/04/2007