Provider First Line Business Practice Location Address:
4121 CHEROKEE AVE APT 13
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:
92104-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-895-3935
Provider Business Practice Location Address Fax Number:
619-895-3935
Provider Enumeration Date:
02/11/2026