Provider First Line Business Practice Location Address:
752 MEDICAL CENTER CT STE 106
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:
91911-6659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-482-8406
Provider Business Practice Location Address Fax Number:
619-482-6656
Provider Enumeration Date:
03/13/2007