Provider First Line Business Practice Location Address:
4080 CENTRE STREET
Provider Second Line Business Practice Location Address:
202
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-795-4422
Provider Business Practice Location Address Fax Number:
619-795-4423
Provider Enumeration Date:
09/14/2012