Provider First Line Business Practice Location Address:
754 MEDICAL CENTER CT STE 103
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:
91911-6655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-397-5001
Provider Business Practice Location Address Fax Number:
619-397-4460
Provider Enumeration Date:
06/06/2006