Provider First Line Business Practice Location Address:
5604 BALBOA AVE
Provider Second Line Business Practice Location Address:
STE. 106
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-492-1000
Provider Business Practice Location Address Fax Number:
858-492-1077
Provider Enumeration Date:
10/02/2006