Provider First Line Business Practice Location Address:
12395 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE. 315
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-3082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-794-5437
Provider Business Practice Location Address Fax Number:
858-794-5439
Provider Enumeration Date:
08/02/2006