Provider First Line Business Practice Location Address:
4954 DEL MONTE 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:
92107-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-764-9681
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2011