Provider First Line Business Practice Location Address:
4632 OREGON ST
Provider Second Line Business Practice Location Address:
# 5
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92116-6006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-518-8740
Provider Business Practice Location Address Fax Number:
619-255-8727
Provider Enumeration Date:
03/18/2008