Provider First Line Business Practice Location Address:
7373 UNIVERSITY AVE STE 211
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:
91942-0524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-881-0428
Provider Business Practice Location Address Fax Number:
619-436-1032
Provider Enumeration Date:
10/18/2018