Provider First Line Business Practice Location Address:
2452 FENTON ST
Provider Second Line Business Practice Location Address:
SUITE #300
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91914-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-946-4133
Provider Business Practice Location Address Fax Number:
619-781-8547
Provider Enumeration Date:
11/27/2007