Provider First Line Business Practice Location Address:
330 K ST
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:
92101-6959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-231-5799
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2013