Provider First Line Business Practice Location Address:
6110 FRIARS RD
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-0171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005