Provider First Line Business Practice Location Address:
4077 5TH AVE
Provider Second Line Business Practice Location Address:
EMS
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-447-0296
Provider Business Practice Location Address Fax Number:
626-623-1227
Provider Enumeration Date:
10/15/2014