Provider First Line Business Practice Location Address:
1558 E H ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91913-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-573-3860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2012