Provider First Line Business Practice Location Address:
6185 AGEE 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:
92122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-552-0402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2006