Provider First Line Business Practice Location Address:
765 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
#211
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-216-3113
Provider Business Practice Location Address Fax Number:
619-216-3204
Provider Enumeration Date:
10/22/2007