Provider First Line Business Practice Location Address:
248 LANDIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-2338
Provider Business Practice Location Address Fax Number:
619-600-4454
Provider Enumeration Date:
12/14/2009