Provider First Line Business Practice Location Address:
4624 W POINT LOMA BLVD
Provider Second Line Business Practice Location Address:
#13
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92107-1480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-665-9317
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2006