Provider First Line Business Practice Location Address:
2751 ROOSEVELT RD
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92106-6180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-743-9177
Provider Business Practice Location Address Fax Number:
619-269-9926
Provider Enumeration Date:
04/06/2007