Provider First Line Business Practice Location Address:
8860 CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-589-2535
Provider Business Practice Location Address Fax Number:
619-589-8042
Provider Enumeration Date:
07/19/2006