Provider First Line Business Practice Location Address:
6312 RIVERDALE ST
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:
92120-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-284-7433
Provider Business Practice Location Address Fax Number:
619-284-7437
Provider Enumeration Date:
04/29/2009