Provider First Line Business Practice Location Address:
402 DICKINSON ST
Provider Second Line Business Practice Location Address:
MPF 3-320
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-6902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-543-1849
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2007