Provider First Line Business Practice Location Address:
6535 ALVARADO RD APT 206
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:
92120-5021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-878-3742
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2026