Provider First Line Business Practice Location Address:
2627 W CANYON AVE
Provider Second Line Business Practice Location Address:
511
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-386-9276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2009