Provider First Line Business Practice Location Address:
2251 WORDEN ST
Provider Second Line Business Practice Location Address:
UNIT 9
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92107-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-518-6301
Provider Business Practice Location Address Fax Number:
866-860-3154
Provider Enumeration Date:
01/08/2009