Provider First Line Business Practice Location Address:
4541 COLLEGE 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:
92115-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-582-5380
Provider Business Practice Location Address Fax Number:
619-582-5404
Provider Enumeration Date:
03/05/2007