Provider First Line Business Practice Location Address:
8881 FLETCHER PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-644-1400
Provider Business Practice Location Address Fax Number:
619-644-1422
Provider Enumeration Date:
07/21/2006