Provider First Line Business Practice Location Address:
9330 CARMEL MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92129-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-687-9013
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2007