Provider First Line Business Practice Location Address:
4060 FAIRMOUNT AVE
Provider Second Line Business Practice Location Address:
OPTOMETRY DEPARTMENT
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-961-0803
Provider Business Practice Location Address Fax Number:
619-269-1257
Provider Enumeration Date:
07/21/2010