Provider First Line Business Practice Location Address:
12750 CARMEL COUNTRY RD
Provider Second Line Business Practice Location Address:
#207
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-794-7844
Provider Business Practice Location Address Fax Number:
858-481-7354
Provider Enumeration Date:
05/16/2007