Provider First Line Business Practice Location Address:
9728 CARMEL MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-484-2560
Provider Business Practice Location Address Fax Number:
858-484-2597
Provider Enumeration Date:
11/16/2006