Provider First Line Business Practice Location Address:
16486 BERNARDO CENTER DR
Provider Second Line Business Practice Location Address:
SUITE C-150
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-335-1072
Provider Business Practice Location Address Fax Number:
858-674-4052
Provider Enumeration Date:
07/12/2006