Provider First Line Business Practice Location Address:
1915 ADAMS 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:
92116-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-546-8005
Provider Business Practice Location Address Fax Number:
619-546-8007
Provider Enumeration Date:
10/17/2006