Provider First Line Business Practice Location Address:
531 16TH 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:
92101-7609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-233-3432
Provider Business Practice Location Address Fax Number:
619-233-7022
Provider Enumeration Date:
08/29/2007