Provider First Line Business Practice Location Address:
752 MEDICAL CENTER CT STE 101
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:
91911-6659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-397-4500
Provider Business Practice Location Address Fax Number:
858-429-7931
Provider Enumeration Date:
03/29/2006