Provider First Line Business Practice Location Address:
1310 ROSECRANS ST STE A
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:
92106-2695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-756-7848
Provider Business Practice Location Address Fax Number:
619-564-7056
Provider Enumeration Date:
11/02/2007