Provider First Line Business Practice Location Address:
8312 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-9323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-855-2344
Provider Business Practice Location Address Fax Number:
619-741-0112
Provider Enumeration Date:
09/14/2010