Provider First Line Business Practice Location Address:
306 WALNUT AVE
Provider Second Line Business Practice Location Address:
#33
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-3560
Provider Business Practice Location Address Fax Number:
619-299-0552
Provider Enumeration Date:
08/02/2006