Provider First Line Business Practice Location Address:
3936 HORTENSIA ST STE 205
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:
92110-2945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-859-2648
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2009