Provider First Line Business Practice Location Address:
6991 BALBOA AVE RM 70
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:
92111-3447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-496-8232
Provider Business Practice Location Address Fax Number:
858-496-8234
Provider Enumeration Date:
05/30/2020