Provider First Line Business Practice Location Address:
17140 BERNARDO CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-2093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-451-5190
Provider Business Practice Location Address Fax Number:
588-451-5199
Provider Enumeration Date:
05/31/2011