Provider First Line Business Practice Location Address:
1325 3RD AVE
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:
91911-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-427-7390
Provider Business Practice Location Address Fax Number:
619-427-3907
Provider Enumeration Date:
05/08/2009