Provider First Line Business Practice Location Address:
319 F ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-2666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-476-1200
Provider Business Practice Location Address Fax Number:
619-420-7849
Provider Enumeration Date:
06/09/2005