Provider First Line Business Practice Location Address:
4747 ORTEN 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:
92110-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-407-6949
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2008