Provider First Line Business Practice Location Address:
11828 RANCHO BERNARDO RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-385-9399
Provider Business Practice Location Address Fax Number:
858-385-9456
Provider Enumeration Date:
01/19/2009