Provider First Line Business Practice Location Address:
352 E L ST
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:
91911-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-2500
Provider Business Practice Location Address Fax Number:
619-934-9578
Provider Enumeration Date:
01/22/2014