Provider First Line Business Practice Location Address:
635 C ST
Provider Second Line Business Practice Location Address:
APT. 502
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-5381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-235-8950
Provider Business Practice Location Address Fax Number:
619-235-8959
Provider Enumeration Date:
10/24/2006