Provider First Line Business Practice Location Address:
3411 3RD AVE
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:
92103-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-0975
Provider Business Practice Location Address Fax Number:
619-291-6738
Provider Enumeration Date:
09/02/2006