Provider First Line Business Practice Location Address:
236 F ST
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:
91910-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-409-4900
Provider Business Practice Location Address Fax Number:
619-409-4994
Provider Enumeration Date:
04/15/2009