Provider First Line Business Practice Location Address:
861 HAROLD PL STE 303
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:
91914-4555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-216-0166
Provider Business Practice Location Address Fax Number:
619-216-1672
Provider Enumeration Date:
03/24/2006