Provider First Line Business Practice Location Address:
750 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-6634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-421-5711
Provider Business Practice Location Address Fax Number:
619-421-5747
Provider Enumeration Date:
05/28/2014