Provider First Line Business Practice Location Address:
1100 INDUSTRIAL BLVD SPC C29
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-2679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-518-3212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2020