Provider First Line Business Practice Location Address:
1105 BROADWAY MENTAL HEALTH SYSTEMS INC.
Provider Second Line Business Practice Location Address:
SUITE 207
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-425-8349
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2007