Provider First Line Business Practice Location Address:
355 3RD AVE STE A
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:
91910-3961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-425-8768
Provider Business Practice Location Address Fax Number:
619-425-8297
Provider Enumeration Date:
07/06/2010