Provider First Line Business Practice Location Address:
316 EAST H STREET
Provider Second Line Business Practice Location Address:
SUITE 701A
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-5304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-422-6130
Provider Business Practice Location Address Fax Number:
619-422-6170
Provider Enumeration Date:
01/17/2007