Provider First Line Business Practice Location Address:
2519 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:
92110-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-276-0747
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2014