Provider First Line Business Practice Location Address:
16935 WEST BERNARDO DRIVE
Provider Second Line Business Practice Location Address:
SUITE 145
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92127-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-485-7027
Provider Business Practice Location Address Fax Number:
858-485-7028
Provider Enumeration Date:
10/18/2006