Provider First Line Business Practice Location Address:
380 E H 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:
91910-7483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-205-5245
Provider Business Practice Location Address Fax Number:
619-691-5950
Provider Enumeration Date:
03/23/2022