Provider First Line Business Practice Location Address:
9320 CARMEL MTN RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92129-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-899-1234
Provider Business Practice Location Address Fax Number:
858-484-5445
Provider Enumeration Date:
01/09/2007