Provider First Line Business Practice Location Address:
12880 CARMEL COUNTRY RD STE D110
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:
92130-3137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-289-4820
Provider Business Practice Location Address Fax Number:
619-349-5864
Provider Enumeration Date:
09/02/2009