Provider First Line Business Practice Location Address:
550 F AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONADO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92118-2199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-522-8921
Provider Business Practice Location Address Fax Number:
619-522-6948
Provider Enumeration Date:
05/08/2026