Provider First Line Business Practice Location Address:
570 PIDGEON ST
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:
92114-4433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-622-4303
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2026