Provider First Line Business Practice Location Address:
12070 CARMEL MOUNTAIN RD STE 292
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:
92128-4651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-676-3926
Provider Business Practice Location Address Fax Number:
858-676-3927
Provider Enumeration Date:
02/02/2007