Provider First Line Business Practice Location Address:
7232 UNIVERSITY AVE
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:
91942-5928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-644-1940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2025