Provider First Line Business Practice Location Address:
3145 ROSECRANS ST.
Provider Second Line Business Practice Location Address:
#F
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-223-7175
Provider Business Practice Location Address Fax Number:
619-223-7030
Provider Enumeration Date:
12/21/2009