Provider First Line Business Practice Location Address:
2445 2ND 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:
92101-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-231-0822
Provider Business Practice Location Address Fax Number:
619-231-1202
Provider Enumeration Date:
05/22/2007