Provider First Line Business Practice Location Address:
681 THIRD AVENUE
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:
91910-5703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-420-2111
Provider Business Practice Location Address Fax Number:
619-585-8130
Provider Enumeration Date:
02/27/2006