Provider First Line Business Practice Location Address:
5998 ALCALA PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-8895
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2011