Provider First Line Business Practice Location Address:
1385 3RD AVE
Provider Second Line Business Practice Location Address:
ROOM 10, 11
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-691-1045
Provider Business Practice Location Address Fax Number:
619-691-1491
Provider Enumeration Date:
09/16/2015