Provider First Line Business Practice Location Address:
5230 CARROLL CANYON RD STE 100
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:
92121-1779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-380-5856
Provider Business Practice Location Address Fax Number:
858-500-5036
Provider Enumeration Date:
07/28/2014