Provider First Line Business Practice Location Address:
4060 HUERFANO AVE
Provider Second Line Business Practice Location Address:
#312
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-5207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-560-7270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2006