Provider First Line Business Practice Location Address:
678 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-5739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-585-4847
Provider Business Practice Location Address Fax Number:
619-585-3458
Provider Enumeration Date:
10/03/2006