Provider First Line Business Practice Location Address:
765 MEDICAL CENTER CT STE 211
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:
91911-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-319-4698
Provider Business Practice Location Address Fax Number:
310-319-4908
Provider Enumeration Date:
09/22/2008