Provider First Line Business Practice Location Address:
1635 3RD AVE
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-5882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-427-4300
Provider Business Practice Location Address Fax Number:
619-427-4301
Provider Enumeration Date:
09/21/2006