Provider First Line Business Practice Location Address:
765 MEDICAL CENTER CT STE 210
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:
619-482-0565
Provider Business Practice Location Address Fax Number:
619-482-2775
Provider Enumeration Date:
10/20/2007