Provider First Line Business Practice Location Address:
754 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
STE. #204
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-6654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-616-2100
Provider Business Practice Location Address Fax Number:
619-616-2104
Provider Enumeration Date:
09/06/2006