Provider First Line Business Practice Location Address:
6833 CLARA LEE 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:
92120-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-916-6226
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2013