Provider First Line Business Practice Location Address:
12350 CARMEL MOUNTAIN RD
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:
92128-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-673-1221
Provider Business Practice Location Address Fax Number:
858-673-1221
Provider Enumeration Date:
01/13/2007