Provider First Line Business Practice Location Address:
6822 FISK 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:
92122-2437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-829-7269
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2011