Provider First Line Business Practice Location Address:
6545 BALBOA AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-3156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-7655
Provider Business Practice Location Address Fax Number:
858-292-0425
Provider Enumeration Date:
09/24/2006