Provider First Line Business Practice Location Address:
5555 GROSSMONT CENTER DR
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:
91942-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-461-1920
Provider Business Practice Location Address Fax Number:
619-461-1919
Provider Enumeration Date:
11/20/2007