Provider First Line Business Practice Location Address:
17631 W BERNARDO DR STE A
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:
92127-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-487-7900
Provider Business Practice Location Address Fax Number:
858-487-1896
Provider Enumeration Date:
09/29/2006