Provider First Line Business Practice Location Address:
769 MEDICAL CENTER CT
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:
91911-6602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-502-5851
Provider Business Practice Location Address Fax Number:
619-502-5865
Provider Enumeration Date:
04/07/2015