Provider First Line Business Practice Location Address:
3020 MEADE AVE STE C
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:
92116-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-851-4243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2008