Provider First Line Business Practice Location Address:
641 E SAN YSIDRO BLVD
Provider Second Line Business Practice Location Address:
B3-128
Provider Business Practice Location Address City Name:
SAN YSIDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92173-3129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-232-7013
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2016