Provider First Line Business Practice Location Address:
4767 ZION 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:
92120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-516-7545
Provider Business Practice Location Address Fax Number:
619-516-7508
Provider Enumeration Date:
06/18/2008