Provider First Line Business Practice Location Address:
2820 ROOSEVELT RD STE 204
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:
92106-6146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-239-1713
Provider Business Practice Location Address Fax Number:
619-239-1713
Provider Enumeration Date:
04/09/2008