Provider First Line Business Practice Location Address:
4765 CARMEL MTN RD
Provider Second Line Business Practice Location Address:
#209
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:
858-481-0080
Provider Business Practice Location Address Fax Number:
866-734-3727
Provider Enumeration Date:
05/01/2007