Provider First Line Business Practice Location Address:
2830 1/2 NYE ST
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:
92111-5406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-283-0117
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2015