Provider First Line Business Practice Location Address:
3944 W POINT LOMA BLVD STE H
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:
92110-5642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-225-6945
Provider Business Practice Location Address Fax Number:
619-225-6946
Provider Enumeration Date:
11/08/2006