Provider First Line Business Practice Location Address:
750 MEDICAL CENTER COURT
Provider Second Line Business Practice Location Address:
SUITE 8, UNIT A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-421-4402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2020