Provider First Line Business Practice Location Address:
1816 HOWARD 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:
92103-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-220-8189
Provider Business Practice Location Address Fax Number:
619-220-8197
Provider Enumeration Date:
02/04/2009