Provider First Line Business Practice Location Address:
2315 OTAY LAKES ROAD
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-389-5700
Provider Business Practice Location Address Fax Number:
714-389-6973
Provider Enumeration Date:
01/18/2007