Provider First Line Business Practice Location Address:
769 MEDICAL CENTER CT.
Provider Second Line Business Practice Location Address:
SUITE # 301
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-6658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-754-6120
Provider Business Practice Location Address Fax Number:
619-482-6656
Provider Enumeration Date:
11/01/2006