Provider First Line Business Practice Location Address:
709 THIRD AVENUE
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:
91910-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-585-3000
Provider Business Practice Location Address Fax Number:
619-585-3002
Provider Enumeration Date:
10/03/2006