Provider First Line Business Practice Location Address:
11986 BERNARDO PLAZA DR
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:
92128-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-485-1704
Provider Business Practice Location Address Fax Number:
858-485-1943
Provider Enumeration Date:
06/21/2006