Provider First Line Business Practice Location Address:
4676 LA CUENTA DR
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:
92124-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-347-5418
Provider Business Practice Location Address Fax Number:
619-374-7180
Provider Enumeration Date:
09/04/2025