Provider First Line Business Practice Location Address:
2251 SAN DIEGO AVE
Provider Second Line Business Practice Location Address:
SUITE B253
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-291-9164
Provider Business Practice Location Address Fax Number:
619-291-9953
Provider Enumeration Date:
06/12/2006