Provider First Line Business Practice Location Address:
9840 CARMEL MOUNTAIN RD
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:
92129-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-240-9953
Provider Business Practice Location Address Fax Number:
858-366-4211
Provider Enumeration Date:
09/30/2019