Provider First Line Business Practice Location Address:
4700 SPRING ST
Provider Second Line Business Practice Location Address:
SUITE # 204
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-5263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-4357
Provider Business Practice Location Address Fax Number:
619-312-2098
Provider Enumeration Date:
08/24/2007