Provider First Line Business Practice Location Address:
12750 CARMEL COUNTRY RD STE 207
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:
92130-2172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-481-4124
Provider Business Practice Location Address Fax Number:
858-481-7354
Provider Enumeration Date:
07/20/2009