Provider First Line Business Practice Location Address:
9340 CARMEL MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92129-2161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-480-1484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006