Provider First Line Business Practice Location Address:
2120 ALPINE BLVD.
Provider Second Line Business Practice Location Address:
ALPINE SPECIAL TREATMENT CENTER
Provider Business Practice Location Address City Name:
ALPINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-659-3120
Provider Business Practice Location Address Fax Number:
619-445-0444
Provider Enumeration Date:
11/09/2007