Provider First Line Business Practice Location Address:
6367 ALVARADO CT
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-7697
Provider Business Practice Location Address Fax Number:
619-287-7698
Provider Enumeration Date:
10/20/2006