Provider First Line Business Practice Location Address:
4215 SPRING ST.
Provider Second Line Business Practice Location Address:
STE. 210
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-7984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-589-8971
Provider Business Practice Location Address Fax Number:
619-461-6194
Provider Enumeration Date:
10/02/2006