Provider First Line Business Practice Location Address:
6719 ALVARADO RD.
Provider Second Line Business Practice Location Address:
SUITE 308
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-265-7912
Provider Business Practice Location Address Fax Number:
619-265-7922
Provider Enumeration Date:
12/19/2006