Provider First Line Business Practice Location Address:
2828 HOWARD AVE APT 10
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:
92104-4367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-305-2015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2026