Provider First Line Business Practice Location Address:
2831 WORDEN ST
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:
92110-5743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-262-5960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2013