Provider First Line Business Practice Location Address:
3211 JEFFERSON 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:
92110-4424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-682-4012
Provider Business Practice Location Address Fax Number:
619-682-4037
Provider Enumeration Date:
02/20/2007