Provider First Line Business Practice Location Address:
2246 BARNEY ST
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:
92139-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-786-8884
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2025