Provider First Line Business Practice Location Address:
3777 4TH AVE
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:
92103-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-704-3737
Provider Business Practice Location Address Fax Number:
619-468-9390
Provider Enumeration Date:
07/26/2010