Provider First Line Business Practice Location Address:
374 EAST H ST A-494
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:
91910-7484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-482-0200
Provider Business Practice Location Address Fax Number:
619-489-2661
Provider Enumeration Date:
12/02/2014