Provider First Line Business Practice Location Address:
3398 CARMEL MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-274-9185
Provider Business Practice Location Address Fax Number:
858-847-9135
Provider Enumeration Date:
05/13/2008