Provider First Line Business Practice Location Address:
5998 ALCALA PARK
Provider Second Line Business Practice Location Address:
SOLES, UNIVERSITY OF SAN DIEGO
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-2476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-5963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2007