Provider First Line Business Practice Location Address:
7484 UNIVERSITY AVE STE 330
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-303-5936
Provider Business Practice Location Address Fax Number:
619-741-8801
Provider Enumeration Date:
03/19/2014