Provider First Line Business Practice Location Address:
2930 CORONADO AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-2187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-423-8414
Provider Business Practice Location Address Fax Number:
619-423-8422
Provider Enumeration Date:
04/24/2009