Provider First Line Business Practice Location Address:
1885 SEFTON PL
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:
92107-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-550-7255
Provider Business Practice Location Address Fax Number:
619-225-2252
Provider Enumeration Date:
01/29/2011