Provider First Line Business Practice Location Address:
5252 BALBOA AVE.
Provider Second Line Business Practice Location Address:
STE. 803
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-6920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-395-7121
Provider Business Practice Location Address Fax Number:
858-256-9308
Provider Enumeration Date:
06/27/2008