Provider First Line Business Practice Location Address:
1339 THIRD 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:
91911-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-426-2040
Provider Business Practice Location Address Fax Number:
619-863-0251
Provider Enumeration Date:
09/22/2020