Provider First Line Business Practice Location Address:
1050 ROSECRANS ST.
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-222-2483
Provider Business Practice Location Address Fax Number:
619-222-2361
Provider Enumeration Date:
11/03/2009