Provider First Line Business Practice Location Address:
883 WORTHINGTON ST
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:
92114-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-498-8541
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2008