Provider First Line Business Practice Location Address:
6367 ALVARADO CT
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-583-7339
Provider Business Practice Location Address Fax Number:
619-287-1662
Provider Enumeration Date:
02/22/2009