Provider First Line Business Practice Location Address:
4295 GESNER ST
Provider Second Line Business Practice Location Address:
SUITE 2D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-6646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-276-1146
Provider Business Practice Location Address Fax Number:
619-276-1246
Provider Enumeration Date:
11/02/2013