Provider First Line Business Practice Location Address:
4168 FRONT ST RM 1-127
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:
92103-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-543-5943
Provider Business Practice Location Address Fax Number:
619-543-6784
Provider Enumeration Date:
08/16/2010