Provider First Line Business Practice Location Address:
1637 3RD AVE
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:
91911-5823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-662-4100
Provider Business Practice Location Address Fax Number:
619-205-1376
Provider Enumeration Date:
08/26/2008