Provider First Line Business Practice Location Address:
1310 ROSECRANS ST STE B
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:
92106-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-405-5785
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2018