Provider First Line Business Practice Location Address:
7851 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-0477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-466-1872
Provider Business Practice Location Address Fax Number:
619-466-2383
Provider Enumeration Date:
08/13/2013