Provider First Line Business Practice Location Address:
4537 COLLEGE AVE
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:
92115-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-229-1895
Provider Business Practice Location Address Fax Number:
619-229-1837
Provider Enumeration Date:
02/03/2006