Provider First Line Business Practice Location Address:
12750 CARMEL COUNTRY RD
Provider Second Line Business Practice Location Address:
SUITE 213
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-481-8107
Provider Business Practice Location Address Fax Number:
858-481-8127
Provider Enumeration Date:
09/26/2006