Provider First Line Business Practice Location Address:
3455 STURTEVANT ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92136-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-556-6671
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2006