Provider First Line Business Practice Location Address:
1014 OLEANDER 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:
91911-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-726-0142
Provider Business Practice Location Address Fax Number:
619-482-7727
Provider Enumeration Date:
11/27/2007