Provider First Line Business Practice Location Address:
3851 ROSECRANS ST # G29
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:
92110-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-692-8801
Provider Business Practice Location Address Fax Number:
619-692-8829
Provider Enumeration Date:
11/14/2007