Provider First Line Business Practice Location Address:
3446 HANCOCK ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-4306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-226-2800
Provider Business Practice Location Address Fax Number:
619-226-2805
Provider Enumeration Date:
01/20/2010