Provider First Line Business Practice Location Address:
3730 3RD 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:
92103-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-2949
Provider Business Practice Location Address Fax Number:
619-297-8535
Provider Enumeration Date:
07/29/2016