Provider First Line Business Practice Location Address:
5111 GARFIELD ST
Provider Second Line Business Practice Location Address:
STE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-698-9375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2006