Provider First Line Business Practice Location Address:
2207 GARNET AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-857-1355
Provider Business Practice Location Address Fax Number:
858-272-7505
Provider Enumeration Date:
09/29/2006