Provider First Line Business Practice Location Address:
480 H ST
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:
91910-4328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-499-2713
Provider Business Practice Location Address Fax Number:
619-585-4390
Provider Enumeration Date:
06/06/2023