Provider First Line Business Practice Location Address:
2221 FELSPAR STREET APT #C
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:
92109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-204-3072
Provider Business Practice Location Address Fax Number:
760-452-6536
Provider Enumeration Date:
12/07/2010