Provider First Line Business Practice Location Address:
3130 5TH 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:
92103-5839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-574-0924
Provider Business Practice Location Address Fax Number:
619-298-3601
Provider Enumeration Date:
09/03/2006