Provider First Line Business Practice Location Address:
3320 KEMPER ST STE 206
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:
92110-4905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-758-6226
Provider Business Practice Location Address Fax Number:
619-758-6255
Provider Enumeration Date:
02/26/2007