Provider First Line Business Practice Location Address:
3650 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:
92116-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-563-0802
Provider Business Practice Location Address Fax Number:
619-563-0633
Provider Enumeration Date:
05/11/2007