Provider First Line Business Practice Location Address:
6475 ALVARADO RD
Provider Second Line Business Practice Location Address:
SUITE 233
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-1223
Provider Business Practice Location Address Fax Number:
858-467-6933
Provider Enumeration Date:
08/13/2006