Provider First Line Business Practice Location Address:
3851 ROSECRANS ST
Provider Second Line Business Practice Location Address:
SUITE S (STD CLINIC)
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-692-8865
Provider Business Practice Location Address Fax Number:
619-692-8543
Provider Enumeration Date:
08/29/2011