Provider First Line Business Practice Location Address:
273 CHURCH 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:
91910-2728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-426-2250
Provider Business Practice Location Address Fax Number:
619-426-7604
Provider Enumeration Date:
09/13/2006