Provider First Line Business Practice Location Address:
2785 KURTZ ST
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-3111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-220-4972
Provider Business Practice Location Address Fax Number:
619-220-8941
Provider Enumeration Date:
12/01/2007