Provider First Line Business Practice Location Address:
738 OTAY LAKES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-6915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-482-9700
Provider Business Practice Location Address Fax Number:
619-482-9703
Provider Enumeration Date:
08/25/2006