Provider First Line Business Practice Location Address:
3731 6TH AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-4383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-291-3515
Provider Business Practice Location Address Fax Number:
619-291-3529
Provider Enumeration Date:
04/01/2015