Provider First Line Business Practice Location Address:
7710 BALBOA AVE
Provider Second Line Business Practice Location Address:
STE 227C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-4079
Provider Business Practice Location Address Fax Number:
858-279-4079
Provider Enumeration Date:
04/23/2007