Provider First Line Business Practice Location Address:
945 HORNBLEND ST
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-4057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-270-6755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2009