Provider First Line Business Practice Location Address:
2400 FENTON ST
Provider Second Line Business Practice Location Address:
SUITE A-100
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91914-3596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-656-3100
Provider Business Practice Location Address Fax Number:
619-216-9006
Provider Enumeration Date:
06/28/2008