Provider First Line Business Practice Location Address:
4765 CARMEL MOUNTAIN RD STE 201
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:
92130-6657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-757-7546
Provider Business Practice Location Address Fax Number:
760-828-9138
Provider Enumeration Date:
11/05/2019