Provider First Line Business Practice Location Address:
5331 MOUNT ALIFAN DR BLDG 200
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:
92111-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-468-2936
Provider Business Practice Location Address Fax Number:
619-510-4626
Provider Enumeration Date:
08/08/2025