Provider First Line Business Practice Location Address:
2036 HORNBLEND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-4638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-270-6711
Provider Business Practice Location Address Fax Number:
858-270-8528
Provider Enumeration Date:
05/03/2007