Provider First Line Business Practice Location Address:
4969 SANTA CRUZ 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:
92107-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-487-0273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2012