Provider First Line Business Practice Location Address:
3214 ADAMS 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:
92116-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-489-9257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2007