Provider First Line Business Practice Location Address:
1537 ROSECRANS ST STE C
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:
92106-2280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-223-1606
Provider Business Practice Location Address Fax Number:
619-795-6094
Provider Enumeration Date:
03/18/2008