Provider First Line Business Practice Location Address:
1241 ESSEX ST
Provider Second Line Business Practice Location Address:
# 1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-688-2480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2011