Provider First Line Business Practice Location Address:
12004 CARMEL MOUNTAIN RD
Provider Second Line Business Practice Location Address:
STUDIO 57 & 58
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-210-5109
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2025