Provider First Line Business Practice Location Address:
4166 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:
92105-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-344-5635
Provider Business Practice Location Address Fax Number:
619-344-5647
Provider Enumeration Date:
04/02/2009