Provider First Line Business Practice Location Address:
4147 ADAMS AVENUE
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:
92116-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-281-1932
Provider Business Practice Location Address Fax Number:
619-281-1947
Provider Enumeration Date:
04/26/2006