Provider First Line Business Practice Location Address:
6571 IMPERIAL AVE
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:
92114-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-262-0781
Provider Business Practice Location Address Fax Number:
619-262-1761
Provider Enumeration Date:
03/05/2009