Provider First Line Business Practice Location Address:
6475 ALVARADO RD
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-287-4678
Provider Business Practice Location Address Fax Number:
619-287-0350
Provider Enumeration Date:
05/16/2007