Provider First Line Business Practice Location Address:
16445 BERNARDO CENTER DR
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:
92128-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-429-0099
Provider Business Practice Location Address Fax Number:
866-266-8027
Provider Enumeration Date:
08/31/2006