Provider First Line Business Practice Location Address:
4777 IMPERIAL AVE
Provider Second Line Business Practice Location Address:
LHS STUDENT HEALTH CENTER
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92113-2071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-266-6502
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007