Provider First Line Business Practice Location Address:
3921 GOLDFINCH ST
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:
92103-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-0335
Provider Business Practice Location Address Fax Number:
619-260-1682
Provider Enumeration Date:
03/20/2007