Provider First Line Business Practice Location Address:
11921 CARMEL CREEK RD
Provider Second Line Business Practice Location Address:
#A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-720-0523
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2008