Provider First Line Business Practice Location Address:
3853 ROSECRANS 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:
92110-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-8225
Provider Business Practice Location Address Fax Number:
619-287-4146
Provider Enumeration Date:
08/20/2009