Provider First Line Business Practice Location Address:
5252 BALBOA AVE
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:
92117-6906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-333-6856
Provider Business Practice Location Address Fax Number:
858-999-2014
Provider Enumeration Date:
10/17/2023