Provider First Line Business Practice Location Address:
690 OTAY LAKES RD.
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-8904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-991-0591
Provider Business Practice Location Address Fax Number:
619-955-5790
Provider Enumeration Date:
09/25/2006