Provider First Line Business Practice Location Address:
8318 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:
91941-3865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-460-8221
Provider Business Practice Location Address Fax Number:
619-462-0121
Provider Enumeration Date:
06/23/2006