Provider First Line Business Practice Location Address:
6699 ALVARADO RD STE 2301
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:
92120-5241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-229-1005
Provider Business Practice Location Address Fax Number:
619-588-4004
Provider Enumeration Date:
09/27/2005