Provider First Line Business Practice Location Address:
3819 1ST AVE UNIT 208
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:
92103-3082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-413-1951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006