Provider First Line Business Practice Location Address:
8808 BALBOA AVE STE 150
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-492-8111
Provider Business Practice Location Address Fax Number:
858-492-3631
Provider Enumeration Date:
11/30/2011