Provider First Line Business Practice Location Address:
5252 BALBOA AVE
Provider Second Line Business Practice Location Address:
SUITE 204
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:
858-480-9118
Provider Business Practice Location Address Fax Number:
858-712-9035
Provider Enumeration Date:
07/07/2008