Provider First Line Business Practice Location Address:
7488 CALZADA DE LA FUENTE, OTAY MESA DETENTION CENTER
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:
92231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-671-8724
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2022