Provider First Line Business Practice Location Address:
730 MEDICAL CENTER CT
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:
91911-6618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-591-5740
Provider Business Practice Location Address Fax Number:
619-591-5744
Provider Enumeration Date:
10/19/2017