Provider First Line Business Practice Location Address:
6435 JOUGLARD 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:
92114-6931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-957-2583
Provider Business Practice Location Address Fax Number:
619-434-6041
Provider Enumeration Date:
02/23/2010