Provider First Line Business Practice Location Address:
12727 CAMINO EMPARRADO
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-265-9992
Provider Business Practice Location Address Fax Number:
858-798-5221
Provider Enumeration Date:
05/24/2018