Provider First Line Business Practice Location Address:
1267 ROSECRANS STREET.
Provider Second Line Business Practice Location Address:
SUITE C
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-226-6506
Provider Business Practice Location Address Fax Number:
619-756-7692
Provider Enumeration Date:
01/25/2006