Provider First Line Business Practice Location Address:
1180 AND 1172 THIRD AVENUE
Provider Second Line Business Practice Location Address:
SUITES C3, C4, C5, C6, AND D1
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-691-8164
Provider Business Practice Location Address Fax Number:
619-426-2359
Provider Enumeration Date:
05/01/2007