Provider First Line Business Practice Location Address:
2930 CORONADO AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-2187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-618-9487
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2011