Provider First Line Business Practice Location Address:
5222 BALBOA AVE STE 31
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:
92117-6952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-277-9669
Provider Business Practice Location Address Fax Number:
858-277-9901
Provider Enumeration Date:
08/31/2006