Provider First Line Business Practice Location Address:
3225 4TH AVE
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:
92103-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-7181
Provider Business Practice Location Address Fax Number:
619-297-9401
Provider Enumeration Date:
02/27/2007