Provider First Line Business Practice Location Address:
12750 CARMEL COUNTRY ROAD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-481-1148
Provider Business Practice Location Address Fax Number:
858-792-9143
Provider Enumeration Date:
12/15/2006