Provider First Line Business Practice Location Address:
342 W SAN YSIDRO BLVD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92173-2495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-428-7432
Provider Business Practice Location Address Fax Number:
619-428-1402
Provider Enumeration Date:
06/18/2006