Provider First Line Business Practice Location Address:
6386 ALVARADO CT
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-4905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-286-6687
Provider Business Practice Location Address Fax Number:
619-286-6695
Provider Enumeration Date:
09/20/2006