Provider First Line Business Practice Location Address:
340 4TH AVE STE 12
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:
91910-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-427-4426
Provider Business Practice Location Address Fax Number:
619-427-8208
Provider Enumeration Date:
06/04/2009