Provider First Line Business Practice Location Address:
3320 KEMPER ST STE 104
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:
92110-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-758-6220
Provider Business Practice Location Address Fax Number:
619-758-6209
Provider Enumeration Date:
05/17/2007