Provider First Line Business Practice Location Address:
2391 ISLAND AVENUE
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:
92102-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-2435
Provider Business Practice Location Address Fax Number:
619-233-2621
Provider Enumeration Date:
07/14/2006