Provider First Line Business Practice Location Address:
8318 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-3865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-838-0307
Provider Business Practice Location Address Fax Number:
619-269-4582
Provider Enumeration Date:
06/14/2006