Provider First Line Business Practice Location Address:
185 WEST SAN YSIDRO BLVD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-428-1103
Provider Business Practice Location Address Fax Number:
619-428-4265
Provider Enumeration Date:
10/27/2006