Provider First Line Business Practice Location Address:
7710 BALBOA AVE
Provider Second Line Business Practice Location Address:
SUITE 228
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-940-7774
Provider Business Practice Location Address Fax Number:
619-377-6701
Provider Enumeration Date:
04/29/2010