Provider First Line Business Practice Location Address:
1052 FELSPAR 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:
92109-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-277-2104
Provider Business Practice Location Address Fax Number:
858-750-6807
Provider Enumeration Date:
04/26/2007