Provider First Line Business Practice Location Address:
4425 VALETA 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:
92107-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-732-8449
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2026