Provider First Line Business Practice Location Address:
310 3RD AVE
Provider Second Line Business Practice Location Address:
STE C11
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-3953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-426-0841
Provider Business Practice Location Address Fax Number:
619-426-9197
Provider Enumeration Date:
01/29/2007