Provider First Line Business Practice Location Address:
230 W PALM 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:
92103-5523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-535-9121
Provider Business Practice Location Address Fax Number:
858-623-8519
Provider Enumeration Date:
08/02/2006