Provider First Line Business Practice Location Address:
6080 LAKE MURRAY BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-466-6666
Provider Business Practice Location Address Fax Number:
619-466-2639
Provider Enumeration Date:
01/27/2007