Provider First Line Business Practice Location Address:
2714 VIA ALTA PL
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:
92108-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-229-5493
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2026