Provider First Line Business Practice Location Address:
754 MEDICAL CENTER CT STE 203
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:
91911-6656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-656-6493
Provider Business Practice Location Address Fax Number:
619-656-5727
Provider Enumeration Date:
02/14/2007