Provider First Line Business Practice Location Address:
5565 GROSSMONT CENTER DRIVE
Provider Second Line Business Practice Location Address:
BLDG 3, SUITE 156
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-462-0900
Provider Business Practice Location Address Fax Number:
619-462-3584
Provider Enumeration Date:
07/29/2006