Provider First Line Business Practice Location Address:
6940 ALVARADO RD STE A
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:
92120-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-7866
Provider Business Practice Location Address Fax Number:
619-287-7893
Provider Enumeration Date:
08/24/2006