Provider First Line Business Practice Location Address:
7839 UNIVERSITY AVE STE 102
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:
91941-4978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-717-0167
Provider Business Practice Location Address Fax Number:
619-393-0830
Provider Enumeration Date:
03/09/2009