Provider First Line Business Practice Location Address:
4183 ALABAMA ST #1
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:
92104-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-204-7985
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2007