Provider First Line Business Practice Location Address:
12710 CARMEL COUNTRY RD
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:
92130-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-499-2600
Provider Business Practice Location Address Fax Number:
619-526-6093
Provider Enumeration Date:
10/03/2006