Provider First Line Business Practice Location Address:
4790 SANTA MONICA AVE
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:
92107-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-208-1898
Provider Business Practice Location Address Fax Number:
619-223-7186
Provider Enumeration Date:
05/04/2006