Provider First Line Business Practice Location Address:
12395 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-3085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-793-3393
Provider Business Practice Location Address Fax Number:
858-793-3383
Provider Enumeration Date:
07/25/2006