Provider First Line Business Practice Location Address:
8804 BALBOA AVE
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:
92123-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-697-3381
Provider Business Practice Location Address Fax Number:
858-637-3011
Provider Enumeration Date:
10/12/2007