Provider First Line Business Practice Location Address:
4602 FINSEN 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:
92122-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-546-0709
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006