Provider First Line Business Practice Location Address:
5252 BALBOA AVE STE 400
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:
92117-6936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-560-4460
Provider Business Practice Location Address Fax Number:
858-560-4467
Provider Enumeration Date:
03/13/2007