Provider First Line Business Practice Location Address:
601 E SAN YSIDRO BLVD STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN YSIDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92173-3138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-374-0005
Provider Business Practice Location Address Fax Number:
619-374-0006
Provider Enumeration Date:
03/16/2026