Provider First Line Business Practice Location Address:
11962 MIL PITRERO RD
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:
92128-5282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-335-4058
Provider Business Practice Location Address Fax Number:
858-376-5513
Provider Enumeration Date:
12/23/2025