Provider First Line Business Practice Location Address:
7373 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-0500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-660-9771
Provider Business Practice Location Address Fax Number:
619-660-9799
Provider Enumeration Date:
04/26/2016