Provider First Line Business Practice Location Address:
401 H ST
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-422-3368
Provider Business Practice Location Address Fax Number:
619-422-3301
Provider Enumeration Date:
08/07/2007