Provider First Line Business Practice Location Address:
680 OLD TELEGRAPH CANYON RD
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-6552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-216-7628
Provider Business Practice Location Address Fax Number:
619-216-7820
Provider Enumeration Date:
01/11/2008