Provider First Line Business Practice Location Address:
286 EUCLID AVE
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92114-3610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-263-6635
Provider Business Practice Location Address Fax Number:
619-263-4686
Provider Enumeration Date:
10/24/2006