Provider First Line Business Practice Location Address:
3702 4TH 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:
92103-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-607-7257
Provider Business Practice Location Address Fax Number:
877-912-4883
Provider Enumeration Date:
12/10/2007