Provider First Line Business Practice Location Address:
7777 ALVARADO RD
Provider Second Line Business Practice Location Address:
SUITE 273
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-460-8500
Provider Business Practice Location Address Fax Number:
619-460-8502
Provider Enumeration Date:
08/10/2006