Provider First Line Business Practice Location Address:
5308 LAKE MURRAY BLVD
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-6120
Provider Business Practice Location Address Fax Number:
619-465-4061
Provider Enumeration Date:
08/29/2006