Provider First Line Business Practice Location Address:
833 TEMPLE ST
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:
92106-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-370-0701
Provider Business Practice Location Address Fax Number:
619-222-4447
Provider Enumeration Date:
03/17/2013