Provider First Line Business Practice Location Address:
8650 GENESEE AVE
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122-1134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-621-7943
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2008