Provider First Line Business Practice Location Address:
5565 GROSSMONT CENTER DRIVE, BLDG. 3
Provider Second Line Business Practice Location Address:
SUITE 540
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-460-2700
Provider Business Practice Location Address Fax Number:
619-460-2702
Provider Enumeration Date:
02/09/2019