Provider First Line Business Practice Location Address:
665 H ST
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-4211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-422-7252
Provider Business Practice Location Address Fax Number:
619-422-5634
Provider Enumeration Date:
07/31/2006