Provider First Line Business Practice Location Address:
4119 FRONT ST
Provider Second Line Business Practice Location Address:
#5
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-302-1819
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2007