Provider First Line Business Practice Location Address:
2878 IMPERIAL 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:
92102-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-238-7393
Provider Business Practice Location Address Fax Number:
619-696-0492
Provider Enumeration Date:
06/10/2011