| PR01920: TYSON & MENDES LLP |
| PSI Provider Number: | S17424 |
| Provider Type: | Independent |
| CE Certification Date: |
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| PL Certification Date: |
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| Address: | 5786 LA JOLLA BLVD LA JOLLA, CA 92037 |
| Web Url: | CMARSHALL@TYSONMENDES.COM |
| Contact: | CAROLYN MARSHALL |
| Telephone: | 858-412-1750 |
| Status: | Pending |
| Termination Date: | N/A |
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