Provider First Line Business Practice Location Address:
239 F 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:
91910-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-427-0810
Provider Business Practice Location Address Fax Number:
619-427-6441
Provider Enumeration Date:
02/21/2007