Provider First Line Business Practice Location Address:
4659 HARBINSON 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:
91942-8752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-336-7008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2026