Provider First Line Business Practice Location Address:
5134 SARATOGA AVE APT 6
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:
92107-2870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-284-2050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2013