Provider First Line Business Practice Location Address:
374 E H ST
Provider Second Line Business Practice Location Address:
SUITE 1710
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-7484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-691-0400
Provider Business Practice Location Address Fax Number:
619-691-1782
Provider Enumeration Date:
02/19/2016