Provider First Line Business Practice Location Address:
5680 LAKE MURRAY BLVD
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:
91942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-3393
Provider Business Practice Location Address Fax Number:
619-465-3394
Provider Enumeration Date:
06/05/2007