Provider First Line Business Practice Location Address:
9340 CARMEL MOUNTAIN RD SUITE E
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-361-6836
Provider Business Practice Location Address Fax Number:
858-780-9953
Provider Enumeration Date:
12/29/2006