Provider First Line Business Practice Location Address:
7435 UNIVERSITY AVE STE 104
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:
91941-6027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-464-3333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007