Provider First Line Business Practice Location Address:
3544 30TH STREET
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:
92104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-2424
Provider Business Practice Location Address Fax Number:
619-683-7588
Provider Enumeration Date:
07/07/2006