Provider First Line Business Practice Location Address:
3855 AVACADO BLVD
Provider Second Line Business Practice Location Address:
#260
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-1706
Provider Business Practice Location Address Fax Number:
619-670-1860
Provider Enumeration Date:
02/13/2007