Provider First Line Business Practice Location Address:
12395 EL CAMINO REAL STE 219
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:
858-793-1011
Provider Business Practice Location Address Fax Number:
858-793-1035
Provider Enumeration Date:
06/28/2010