Provider First Line Business Practice Location Address:
5252 BALBOA ARMS DR UNIT 284
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:
92117-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-731-8709
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2023