Provider First Line Business Practice Location Address:
12395 EL CAMINO REAL STE 101
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:
92130-3083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-350-0337
Provider Business Practice Location Address Fax Number:
858-350-9644
Provider Enumeration Date:
01/30/2007