Provider First Line Business Practice Location Address:
4427 EUCLID 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:
92115-4523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-1235
Provider Business Practice Location Address Fax Number:
619-287-1353
Provider Enumeration Date:
11/08/2006