Provider First Line Business Practice Location Address:
12580 CARMEL CREEK RD
Provider Second Line Business Practice Location Address:
#52
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-322-0341
Provider Business Practice Location Address Fax Number:
858-509-0341
Provider Enumeration Date:
11/06/2006