Provider First Line Business Practice Location Address:
11333 ZAPATA AVE UNIT 29
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:
92126-4778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-549-4235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2026