Provider First Line Business Practice Location Address:
11 NAPLES ST
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:
91911-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-426-5640
Provider Business Practice Location Address Fax Number:
619-426-1763
Provider Enumeration Date:
09/22/2006