Provider First Line Business Practice Location Address:
4627 CARMEL MOUNTAIN RD
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:
92130-6613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-523-1847
Provider Business Practice Location Address Fax Number:
858-523-1842
Provider Enumeration Date:
11/01/2010