Provider First Line Business Practice Location Address:
6135 ACORN 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:
92115-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-895-6751
Provider Business Practice Location Address Fax Number:
619-287-2239
Provider Enumeration Date:
06/19/2007