Provider First Line Business Practice Location Address:
5480 BALTIMORE DR STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-2066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-917-4675
Provider Business Practice Location Address Fax Number:
619-303-3306
Provider Enumeration Date:
09/12/2013