Provider First Line Business Practice Location Address:
5115 GARFIELD ST
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:
91941-5122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-282-1338
Provider Business Practice Location Address Fax Number:
619-282-1227
Provider Enumeration Date:
11/07/2006