Provider First Line Business Practice Location Address:
15720 BERNARDO CENTER DRIVE
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:
92127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-672-9247
Provider Business Practice Location Address Fax Number:
858-672-9247
Provider Enumeration Date:
09/16/2006