Provider First Line Business Practice Location Address:
3715 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:
92103-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-291-0473
Provider Business Practice Location Address Fax Number:
619-220-6015
Provider Enumeration Date:
11/15/2006