Provider First Line Business Practice Location Address:
3815 GEORGIA ST
Provider Second Line Business Practice Location Address:
APT 102
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-7614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-820-7770
Provider Business Practice Location Address Fax Number:
619-955-8520
Provider Enumeration Date:
10/18/2007