Provider First Line Business Practice Location Address:
11968 BERNARDO PLAZA DR
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:
92128-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-521-0000
Provider Business Practice Location Address Fax Number:
858-521-0404
Provider Enumeration Date:
11/10/2011