Provider First Line Business Practice Location Address:
1626 ADAMS 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:
92116-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-334-3607
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2026