Provider First Line Business Practice Location Address:
6465 BALBOA AVE STE 101
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:
92111-3124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-278-0111
Provider Business Practice Location Address Fax Number:
858-278-2512
Provider Enumeration Date:
12/27/2006