Provider First Line Business Practice Location Address:
9728 CARMEL MOUNTAIN RD STE B
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:
92129-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-484-2460
Provider Business Practice Location Address Fax Number:
858-484-2597
Provider Enumeration Date:
08/31/2007