Provider First Line Business Practice Location Address:
4700 SPRING ST
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-5263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-4700
Provider Business Practice Location Address Fax Number:
619-589-6840
Provider Enumeration Date:
09/09/2005