Provider First Line Business Practice Location Address:
5998 ALCALA PARK
Provider Second Line Business Practice Location Address:
STUDENT HEALTH CENTER, MAHER HALL 140
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-2492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-4595
Provider Business Practice Location Address Fax Number:
610-260-2375
Provider Enumeration Date:
02/21/2017