Provider First Line Business Practice Location Address:
2700 ADAMS AVE STE 209
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:
92116-1367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-338-5200
Provider Business Practice Location Address Fax Number:
619-684-3790
Provider Enumeration Date:
04/02/2019