Provider First Line Business Practice Location Address:
9075 CREEKFORD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKESIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-685-1175
Provider Business Practice Location Address Fax Number:
619-234-3759
Provider Enumeration Date:
12/04/2007