Provider First Line Business Practice Location Address:
6495 ALVARADO RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-8870
Provider Business Practice Location Address Fax Number:
619-287-0640
Provider Enumeration Date:
07/22/2006