Provider First Line Business Practice Location Address:
4620 ALVARADO CANYON RD
Provider Second Line Business Practice Location Address:
UNIT 14
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:
858-308-6394
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2023