Provider First Line Business Practice Location Address:
16776 BERNARDO CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-2669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-675-1112
Provider Business Practice Location Address Fax Number:
858-675-1141
Provider Enumeration Date:
05/01/2006