Provider First Line Business Practice Location Address:
2132 LINCOLN AVE
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:
92104-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-317-8345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2008