Provider First Line Business Practice Location Address:
344 E H STREET
Provider Second Line Business Practice Location Address:
SUITE 1402
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-422-2121
Provider Business Practice Location Address Fax Number:
619-422-2427
Provider Enumeration Date:
03/16/2007