Provider First Line Business Practice Location Address:
16466 BERNARDO CENTER DR
Provider Second Line Business Practice Location Address:
STE. 185
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-676-1845
Provider Business Practice Location Address Fax Number:
858-676-0075
Provider Enumeration Date:
01/31/2007