Provider First Line Business Practice Location Address:
3215 JUNIPER 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:
92104-5625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-518-2832
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2013