Provider First Line Business Practice Location Address:
7710 BALBOA AVE STE 329
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:
92111-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-642-4284
Provider Business Practice Location Address Fax Number:
619-487-0218
Provider Enumeration Date:
09/16/2022