Provider First Line Business Practice Location Address:
11860 CARMEL CREEK 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:
92130-2474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-804-3748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2020