Provider First Line Business Practice Location Address:
15950 BERNARDO CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-487-9040
Provider Business Practice Location Address Fax Number:
858-487-8387
Provider Enumeration Date:
12/02/2010