Provider First Line Business Practice Location Address:
8808 BALBOA AVENUE
Provider Second Line Business Practice Location Address:
TOC CLAIREMONT
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-569-6460
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2007