Provider First Line Business Practice Location Address:
4620 ALVARADO CANYON RD
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-4320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-229-9695
Provider Business Practice Location Address Fax Number:
619-229-9666
Provider Enumeration Date:
01/19/2013