Provider First Line Business Practice Location Address:
239 LAUREL ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-1472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-220-2008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2010