Provider First Line Business Practice Location Address:
300 F ST
Provider Second Line Business Practice Location Address:
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:
91910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-272-2662
Provider Business Practice Location Address Fax Number:
858-272-2661
Provider Enumeration Date:
10/07/2025