Provider First Line Business Practice Location Address:
6699 ALVARADO RD
Provider Second Line Business Practice Location Address:
#2301
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-582-2595
Provider Business Practice Location Address Fax Number:
619-229-8006
Provider Enumeration Date:
09/16/2006