Provider First Line Business Practice Location Address:
1450 FRAZEE RD
Provider Second Line Business Practice Location Address:
209
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-574-6678
Provider Business Practice Location Address Fax Number:
619-574-6680
Provider Enumeration Date:
02/07/2007