Provider First Line Business Practice Location Address:
4765 CARMEL MOUNTAIN RD STE 102
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:
92130-6657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-259-0553
Provider Business Practice Location Address Fax Number:
858-259-0518
Provider Enumeration Date:
05/05/2009