Provider First Line Business Practice Location Address:
3853 ROSECRANS 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:
92110-2670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-692-8275
Provider Business Practice Location Address Fax Number:
619-692-8315
Provider Enumeration Date:
11/29/2006