Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Apr 15, 2014
License(s)
5101025821 (MI), 20A15471 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 823 GATEWAY CENTER WAY | San Diego, CA 92102-4541 | 619-515-2300 |
| LOCATION | 4725 MARKET ST | San Diego, CA 92102-4715 | 619-515-2560 |
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