Provider First Line Business Practice Location Address:
754 MEDICAL CENTER CT STE 201
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:
91911-6656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-656-9222
Provider Business Practice Location Address Fax Number:
619-656-9322
Provider Enumeration Date:
08/17/2006