Provider First Line Business Practice Location Address:
750 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-6634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-421-6741
Provider Business Practice Location Address Fax Number:
619-421-3777
Provider Enumeration Date:
07/25/2006