Provider First Line Business Practice Location Address:
3242 ASHFORD ST
Provider Second Line Business Practice Location Address:
UNITE J
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-5056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-439-0633
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2013