Provider First Line Business Practice Location Address:
374 EAST H ST
Provider Second Line Business Practice Location Address:
STE 1708
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-7484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-425-7990
Provider Business Practice Location Address Fax Number:
619-425-7992
Provider Enumeration Date:
05/03/2006