Provider First Line Business Practice Location Address:
12750 CARMEL COUNTRY RD STE. A111
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:
92130-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-794-4007
Provider Business Practice Location Address Fax Number:
858-792-4004
Provider Enumeration Date:
01/03/2007