Provider First Line Business Practice Location Address:
12125 ALTA CARMEL CT STE 330
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:
92128-3841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-451-0908
Provider Business Practice Location Address Fax Number:
858-596-2110
Provider Enumeration Date:
10/24/2006