Provider First Line Business Practice Location Address:
16925 W BERNARDO DR
Provider Second Line Business Practice Location Address:
SUITE 236 B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-674-9900
Provider Business Practice Location Address Fax Number:
858-674-9715
Provider Enumeration Date:
12/11/2006