Provider First Line Business Practice Location Address:
340 4TH AVE STE 6
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:
858-294-4242
Provider Business Practice Location Address Fax Number:
858-294-3466
Provider Enumeration Date:
12/14/2021