Provider First Line Business Practice Location Address:
138 B AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONADO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92118-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-437-6209
Provider Business Practice Location Address Fax Number:
619-435-2063
Provider Enumeration Date:
11/02/2006