Provider First Line Business Practice Location Address:
4204 ADAMS AVE
Provider Second Line Business Practice Location Address:
A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-431-5049
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2023