Provider First Line Business Practice Location Address:
6719 ALVARADO RD STE 207
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:
92120-5252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-265-2152
Provider Business Practice Location Address Fax Number:
619-265-2167
Provider Enumeration Date:
10/28/2021