Provider First Line Business Practice Location Address:
1635 3RD AVE
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-5883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-420-4132
Provider Business Practice Location Address Fax Number:
619-420-0503
Provider Enumeration Date:
05/03/2007