Provider First Line Business Practice Location Address:
5111 GARFIELD STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-460-4050
Provider Business Practice Location Address Fax Number:
619-460-7441
Provider Enumeration Date:
01/24/2006