Provider First Line Business Practice Location Address:
4075 ALDER DR
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92116-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-417-9690
Provider Business Practice Location Address Fax Number:
619-923-3611
Provider Enumeration Date:
02/02/2009