Provider First Line Business Practice Location Address:
6565 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:
92111-3154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-729-2122
Provider Business Practice Location Address Fax Number:
858-279-5495
Provider Enumeration Date:
11/06/2006