Provider First Line Business Practice Location Address:
13140 LUMEN WAY
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:
92130-2984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-871-8535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2026