Provider First Line Business Practice Location Address:
310 THIRD AVE STE C1B
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:
91910-3954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-476-1600
Provider Business Practice Location Address Fax Number:
619-476-1600
Provider Enumeration Date:
03/28/2023