Provider First Line Business Practice Location Address:
5252 BALBOA AV.
Provider Second Line Business Practice Location Address:
SUITE 707
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-977-0421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2014