Provider First Line Business Practice Location Address:
5252 BALBOA AVE STE 1002
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:
92117-7011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-278-2181
Provider Business Practice Location Address Fax Number:
858-277-2183
Provider Enumeration Date:
07/11/2006