Provider First Line Business Practice Location Address:
7200 PARKWAY DR
Provider Second Line Business Practice Location Address:
STE 115
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-1534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-463-5883
Provider Business Practice Location Address Fax Number:
619-463-5888
Provider Enumeration Date:
03/22/2006