Provider First Line Business Practice Location Address:
7122 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:
91942-5926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-698-5471
Provider Business Practice Location Address Fax Number:
619-698-3075
Provider Enumeration Date:
02/19/2007