Provider First Line Business Practice Location Address:
7777 ALVARADO RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-8216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-463-7797
Provider Business Practice Location Address Fax Number:
619-463-1351
Provider Enumeration Date:
04/18/2007