Provider First Line Business Practice Location Address:
12395 EL CAMINO REAL STE 217
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:
92130-3084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-481-1151
Provider Business Practice Location Address Fax Number:
858-481-1333
Provider Enumeration Date:
06/23/2006