Provider First Line Business Practice Location Address:
2204 NATIONAL AVE
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:
92113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-2355
Provider Business Practice Location Address Fax Number:
619-232-7011
Provider Enumeration Date:
02/07/2007