Provider First Line Business Practice Location Address:
3851 ROSECRANS ST STE 522
Provider Second Line Business Practice Location Address:
MS P511H
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-692-8819
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006