Provider First Line Business Practice Location Address:
13176 CALLE DE LOS NINOS SAN DIEGO, CA 92129 2919
Provider Second Line Business Practice Location Address:
1415 RIDGEBACK ROAD #4
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-6983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-421-4257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2006