Provider First Line Business Practice Location Address:
16769 BERNARDO CENTER DR # K-25
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:
92128-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-451-6668
Provider Business Practice Location Address Fax Number:
858-451-9799
Provider Enumeration Date:
10/30/2007