Provider First Line Business Practice Location Address:
2624 ANGELL AVE
Provider Second Line Business Practice Location Address:
NONE
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-997-4105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2008