Provider First Line Business Practice Location Address:
5033 KILKEE 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:
92117-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-920-3812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2014