Provider First Line Business Practice Location Address:
360 H STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-397-5400
Provider Business Practice Location Address Fax Number:
619-397-5445
Provider Enumeration Date:
11/08/2007