Provider First Line Business Practice Location Address:
2117 MONROE AVE APT SUITE
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:
92116-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-549-3400
Provider Business Practice Location Address Fax Number:
858-549-3405
Provider Enumeration Date:
10/28/2025