Provider First Line Business Practice Location Address:
5525 GROSSMONT CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-644-6500
Provider Business Practice Location Address Fax Number:
619-644-6539
Provider Enumeration Date:
05/03/2006