Provider First Line Business Practice Location Address:
4350 OTAY MESA RD
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:
92173-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-428-4476
Provider Business Practice Location Address Fax Number:
619-428-6473
Provider Enumeration Date:
06/03/2013