Provider First Line Business Practice Location Address:
7171 ALVARADO RD STE 100A
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:
91942-8996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-562-2130
Provider Business Practice Location Address Fax Number:
619-562-2584
Provider Enumeration Date:
04/29/2006