Provider First Line Business Practice Location Address:
1180 ROSECRANS ST STE 107
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:
92106-2660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-271-6447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2026