Provider First Line Business Practice Location Address:
9019 PARK PLAZA DR STE D
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:
91942-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-606-6464
Provider Business Practice Location Address Fax Number:
619-579-8573
Provider Enumeration Date:
05/22/2006