Provider First Line Business Practice Location Address:
3935 32ND ST
Provider Second Line Business Practice Location Address:
#6
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-889-1831
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2011