Provider First Line Business Practice Location Address:
2226 OTAY LAKES RD STE A
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:
91915-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-216-7336
Provider Business Practice Location Address Fax Number:
619-216-2084
Provider Enumeration Date:
11/14/2006