Provider First Line Business Practice Location Address:
301 3RD AVE
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:
91910-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-476-1444
Provider Business Practice Location Address Fax Number:
619-476-0656
Provider Enumeration Date:
11/07/2006