Provider First Line Business Practice Location Address:
12395 EL CAMINO REAL SUITE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-350-5555
Provider Business Practice Location Address Fax Number:
858-350-5139
Provider Enumeration Date:
07/23/2006