Provider First Line Business Practice Location Address:
110 1/2 W PENNSYLVANIA 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:
92103-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-948-8926
Provider Business Practice Location Address Fax Number:
619-255-3870
Provider Enumeration Date:
02/03/2006