Provider First Line Business Practice Location Address:
9912 CARMEL MOUNTAIN RD STE A
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:
92129-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-484-6418
Provider Business Practice Location Address Fax Number:
858-484-6318
Provider Enumeration Date:
05/14/2007