Provider First Line Business Practice Location Address:
220 DICKINSON ST
Provider Second Line Business Practice Location Address:
SUITE: A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-543-2688
Provider Business Practice Location Address Fax Number:
619-543-3991
Provider Enumeration Date:
03/31/2009