Provider First Line Business Practice Location Address:
11943 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-216-7336
Provider Business Practice Location Address Fax Number:
619-216-2084
Provider Enumeration Date:
07/17/2013