Provider First Line Business Practice Location Address:
16935 W BERNARDO DR STE 110
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:
92127-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-480-1234
Provider Business Practice Location Address Fax Number:
760-480-1234
Provider Enumeration Date:
07/25/2006