Provider First Line Business Practice Location Address:
14125 CUCA 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:
92129-1852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-672-3600
Provider Business Practice Location Address Fax Number:
858-672-4390
Provider Enumeration Date:
08/24/2026