Provider First Line Business Practice Location Address:
3851 ROSECRANS ST
Provider Second Line Business Practice Location Address:
P501C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-692-8419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2007