Provider First Line Business Practice Location Address:
12750 CARMEL COUNTRY RD STE 215
Provider Second Line Business Practice Location Address:
SUITE # 215
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-259-1400
Provider Business Practice Location Address Fax Number:
858-259-1401
Provider Enumeration Date:
05/09/2006