Provider First Line Business Practice Location Address:
3229 ERIE 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:
92117-6151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-339-1866
Provider Business Practice Location Address Fax Number:
619-276-4892
Provider Enumeration Date:
03/18/2006