Provider First Line Business Practice Location Address:
2165 SAN DIEGO AVE STE 101
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:
92110-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-779-0078
Provider Business Practice Location Address Fax Number:
619-407-9049
Provider Enumeration Date:
05/21/2010