Provider First Line Business Practice Location Address:
3174 DENVER ST
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:
92117-6141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-351-1952
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2010