Provider First Line Business Practice Location Address:
752 MEDICAL CENTER CT STE 103
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:
91911-6659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-482-0300
Provider Business Practice Location Address Fax Number:
619-240-3548
Provider Enumeration Date:
08/29/2008