Provider First Line Business Practice Location Address:
3312 5TH 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:
92103-5713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-261-8510
Provider Business Practice Location Address Fax Number:
619-623-3325
Provider Enumeration Date:
11/18/2008