Provider First Line Business Practice Location Address:
2121 SAN DIEGO AVE. (664BU)
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:
92110-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-497-8467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2012