Provider First Line Business Practice Location Address:
4765 CARMEL MOUNTAIN RD STE 105
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:
92130-6657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-481-8248
Provider Business Practice Location Address Fax Number:
858-481-8612
Provider Enumeration Date:
01/15/2007