Provider First Line Business Practice Location Address:
8356 ALLISON AVE
Provider Second Line Business Practice Location Address:
SUITE A-2
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-3857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-698-9787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2007