Provider First Line Business Practice Location Address:
16496 BERNARDO CENTER DR
Provider Second Line Business Practice Location Address:
310
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-2524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-451-2120
Provider Business Practice Location Address Fax Number:
858-486-1245
Provider Enumeration Date:
12/27/2006