Provider First Line Business Practice Location Address:
4204 ADAMS AVE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-477-8821
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2018