Provider First Line Business Practice Location Address:
353 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:
91910-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-409-1600
Provider Business Practice Location Address Fax Number:
619-476-6030
Provider Enumeration Date:
07/20/2015