Provider First Line Business Practice Location Address:
10136 ZAPATA AVE
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:
92126-1124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-663-2425
Provider Business Practice Location Address Fax Number:
858-430-5555
Provider Enumeration Date:
01/08/2026