Provider First Line Business Practice Location Address:
4765 CARMEL MOUNTAIN RD., SUITE 201
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:
858-259-3223
Provider Business Practice Location Address Fax Number:
858-259-3221
Provider Enumeration Date:
10/19/2012