Provider First Line Business Practice Location Address:
2185 GARNET AVE
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:
92109-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
185-827-0927
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2026