Provider First Line Business Practice Location Address:
446 26TH ST FL 6
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:
92102-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-446-7456
Provider Business Practice Location Address Fax Number:
619-398-2168
Provider Enumeration Date:
12/04/2006