Provider First Line Business Practice Location Address:
3940 HANCOCK ST
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-5157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-224-7822
Provider Business Practice Location Address Fax Number:
619-224-7822
Provider Enumeration Date:
11/07/2006