Provider First Line Business Practice Location Address:
642 3RD AVE STE F
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:
91910-5733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-427-7030
Provider Business Practice Location Address Fax Number:
619-427-1428
Provider Enumeration Date:
01/08/2010