Provider First Line Business Practice Location Address:
1267 ROSECRANS ST STE E
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:
92106-2692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-222-8141
Provider Business Practice Location Address Fax Number:
619-222-9642
Provider Enumeration Date:
11/20/2006