Provider First Line Business Practice Location Address:
4382 ROUS 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:
92122-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-558-7342
Provider Business Practice Location Address Fax Number:
858-492-7290
Provider Enumeration Date:
11/12/2009