Provider First Line Business Practice Location Address:
3356 2ND AVE STE I
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:
92103-5636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-729-2339
Provider Business Practice Location Address Fax Number:
619-562-6718
Provider Enumeration Date:
04/17/2007