Provider First Line Business Practice Location Address:
2308 6TH 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:
92101-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-546-0420
Provider Business Practice Location Address Fax Number:
619-615-2346
Provider Enumeration Date:
03/25/2011