Provider First Line Business Practice Location Address:
9449 BALBOA AVE STE 105
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:
92123-4336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-569-4545
Provider Business Practice Location Address Fax Number:
858-569-4546
Provider Enumeration Date:
03/05/2007