Provider First Line Business Practice Location Address:
601 E SAN YSIDRO BLVD
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
SAN YSIDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92173-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-662-9001
Provider Business Practice Location Address Fax Number:
619-662-9007
Provider Enumeration Date:
11/10/2006