Provider First Line Business Practice Location Address:
2838 GARRISON 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:
92106-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-840-0845
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2006