Provider First Line Business Practice Location Address:
11835 CARMEL MTN RD
Provider Second Line Business Practice Location Address:
#1306
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-485-5552
Provider Business Practice Location Address Fax Number:
858-485-1033
Provider Enumeration Date:
02/15/2007