Provider First Line Business Practice Location Address:
6737 BALLINGER 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:
92119-1824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-250-2226
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2021