Provider First Line Business Practice Location Address:
9888 CARROLL CENTRE RD
Provider Second Line Business Practice Location Address:
SUITE #120
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-722-6332
Provider Business Practice Location Address Fax Number:
888-514-1239
Provider Enumeration Date:
06/22/2007