Provider First Line Business Practice Location Address:
3020 COLUMBINE ST
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:
92105-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-282-5422
Provider Business Practice Location Address Fax Number:
619-283-3855
Provider Enumeration Date:
08/17/2007