Provider First Line Business Practice Location Address:
880 THIRD 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:
91911-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-662-4100
Provider Business Practice Location Address Fax Number:
619-573-6491
Provider Enumeration Date:
03/12/2026