Provider First Line Business Practice Location Address:
5544 BALBOA ARMS 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:
92117-5077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-278-1944
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2006