Provider First Line Business Practice Location Address:
5252 BALBOA AVE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-6906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-410-5545
Provider Business Practice Location Address Fax Number:
858-874-2944
Provider Enumeration Date:
10/14/2006