Provider First Line Business Practice Location Address:
12075 CARMEL MOUNTAIN RD STE 210
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:
92128-4613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-487-6453
Provider Business Practice Location Address Fax Number:
858-487-6474
Provider Enumeration Date:
01/26/2007