Provider First Line Business Practice Location Address:
7851 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-4977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-589-6060
Provider Business Practice Location Address Fax Number:
619-589-6094
Provider Enumeration Date:
02/26/2007