Provider First Line Business Practice Location Address:
7257 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:
91941-5927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-583-0454
Provider Business Practice Location Address Fax Number:
619-465-1634
Provider Enumeration Date:
04/07/2006