Provider First Line Business Practice Location Address:
5525 GROSSMONT CENTER DR
Provider Second Line Business Practice Location Address:
SUITE # 606
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:
619-668-4700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007