Provider First Line Business Practice Location Address:
3288 ADAMS 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:
92116-1646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-992-4716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2011