Provider First Line Business Practice Location Address:
754 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-6654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-482-4333
Provider Business Practice Location Address Fax Number:
619-482-4445
Provider Enumeration Date:
04/24/2006