Provider First Line Business Practice Location Address:
2060 OTAY LAKES RD STE 110
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:
91913-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-373-9222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2012