Provider First Line Business Practice Location Address:
4152 32ND ST
Provider Second Line Business Practice Location Address:
#11
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-2032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-554-4836
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2013