Provider First Line Business Practice Location Address:
3340 KEMPER ST
Provider Second Line Business Practice Location Address:
SUITE 101, 103, 104 & 205
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-758-1433
Provider Business Practice Location Address Fax Number:
619-758-9823
Provider Enumeration Date:
03/01/2007