Provider First Line Business Practice Location Address:
286 EUCLID AVE
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92114-3610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-527-0051
Provider Business Practice Location Address Fax Number:
619-527-0056
Provider Enumeration Date:
12/18/2007