Provider First Line Business Practice Location Address:
6699 ALVARADO RD
Provider Second Line Business Practice Location Address:
SUITE 2308
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-462-9010
Provider Business Practice Location Address Fax Number:
619-287-8165
Provider Enumeration Date:
02/28/2007