Provider First Line Business Practice Location Address:
6367 ALVARADO CT
Provider Second Line Business Practice Location Address:
#104
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-229-1211
Provider Business Practice Location Address Fax Number:
619-229-1141
Provider Enumeration Date:
04/27/2006