Provider First Line Business Practice Location Address:
1370 ROSECRANS ST
Provider Second Line Business Practice Location Address:
SUITE. #C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92106-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-866-1414
Provider Business Practice Location Address Fax Number:
619-757-1478
Provider Enumeration Date:
12/06/2006