Provider First Line Business Practice Location Address:
12250 EL CAMIO REAL ST
Provider Second Line Business Practice Location Address:
STE 190
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:
858-793-1460
Provider Business Practice Location Address Fax Number:
858-793-1989
Provider Enumeration Date:
04/04/2006