Provider First Line Business Practice Location Address:
7773 UNIVERSITY 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:
91941-4950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-3000
Provider Business Practice Location Address Fax Number:
619-465-3003
Provider Enumeration Date:
10/17/2006