Provider First Line Business Practice Location Address:
7871 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-0471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-8270
Provider Business Practice Location Address Fax Number:
619-287-8272
Provider Enumeration Date:
07/22/2005