Provider First Line Business Practice Location Address:
6367 ALVARADO CT
Provider Second Line Business Practice Location Address:
STE 101
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:
619-583-7002
Provider Business Practice Location Address Fax Number:
619-583-9404
Provider Enumeration Date:
04/09/2008