Provider First Line Business Practice Location Address:
1738 WHALEY AVE
Provider Second Line Business Practice Location Address:
ADMINISTRATIVE/TELEHEALTH
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-5752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-459-2124
Provider Business Practice Location Address Fax Number:
917-459-2124
Provider Enumeration Date:
02/10/2026