Provider First Line Business Practice Location Address:
8851 CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-461-3880
Provider Business Practice Location Address Fax Number:
619-461-3895
Provider Enumeration Date:
09/29/2005