Provider First Line Business Practice Location Address:
256 LANDIS AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-427-0652
Provider Business Practice Location Address Fax Number:
619-427-0660
Provider Enumeration Date:
09/11/2006