Provider First Line Business Practice Location Address:
360 H 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:
91910-5511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-585-7227
Provider Business Practice Location Address Fax Number:
619-585-3190
Provider Enumeration Date:
10/18/2005