Provider First Line Business Practice Location Address:
7771 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:
91942-4950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-466-9255
Provider Business Practice Location Address Fax Number:
619-466-9254
Provider Enumeration Date:
07/28/2006