Provider First Line Business Practice Location Address:
6719 ALVARADO RD
Provider Second Line Business Practice Location Address:
206
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-9100
Provider Business Practice Location Address Fax Number:
619-287-4536
Provider Enumeration Date:
10/03/2005