Provider First Line Business Practice Location Address:
302 WASHINGTON ST
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:
92103-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-281-7859
Provider Business Practice Location Address Fax Number:
619-546-8552
Provider Enumeration Date:
09/02/2016