Provider First Line Business Practice Location Address:
3851 ROSECRANS ST
Provider Second Line Business Practice Location Address:
STE., 704
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:
619-692-8691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2007