Provider First Line Business Practice Location Address:
3340 KEMPER ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-523-8121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2016