Provider First Line Business Practice Location Address:
13859 CARMEL VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-5665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-484-9090
Provider Business Practice Location Address Fax Number:
858-484-9211
Provider Enumeration Date:
06/06/2006