Provider First Line Business Practice Location Address:
4653 CARMEL MOUNTAIN RD
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:
92130-6650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-330-0065
Provider Business Practice Location Address Fax Number:
858-216-8033
Provider Enumeration Date:
04/30/2008