Provider First Line Business Practice Location Address:
835 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:
91911-1352
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:
619-409-1612
Provider Enumeration Date:
05/08/2006