Provider First Line Business Practice Location Address:
12588 CARMEL CREEK RD UNIT 31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-871-8827
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2014