Provider First Line Business Practice Location Address:
752 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
SUITE 101
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-482-0565
Provider Business Practice Location Address Fax Number:
619-482-2775
Provider Enumeration Date:
07/08/2006