Provider First Line Business Practice Location Address:
4419 EUCLID AVE
Provider Second Line Business Practice Location Address:
SUITE #105
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-4564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-582-2079
Provider Business Practice Location Address Fax Number:
619-582-2075
Provider Enumeration Date:
11/16/2010