Provider First Line Business Practice Location Address:
3740 ROSECRANS ST STE C
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:
92110-3126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-222-5433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2015