Provider First Line Business Practice Location Address:
12395 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 105
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:
858-259-2950
Provider Business Practice Location Address Fax Number:
858-259-2968
Provider Enumeration Date:
10/02/2006