Provider First Line Business Practice Location Address:
3319 UDALL 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:
92106-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-224-7337
Provider Business Practice Location Address Fax Number:
619-255-8617
Provider Enumeration Date:
07/15/2011