Provider First Line Business Practice Location Address:
5565 GROSSMONT CTR DR
Provider Second Line Business Practice Location Address:
BLDG 3 STE 156
Provider Business Practice Location Address City Name:
LAMESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-462-0900
Provider Business Practice Location Address Fax Number:
619-462-3584
Provider Enumeration Date:
08/30/2006