Provider First Line Business Practice Location Address:
9888-D CARMEL MOUNTAIN RD
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:
92129-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-484-0770
Provider Business Practice Location Address Fax Number:
858-484-0708
Provider Enumeration Date:
08/10/2006