Provider First Line Business Practice Location Address:
1060 S EUCLID AVE
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:
92114-6203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-262-6862
Provider Business Practice Location Address Fax Number:
619-262-9582
Provider Enumeration Date:
12/08/2005