Provider First Line Business Practice Location Address:
8366 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-9343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-463-9301
Provider Business Practice Location Address Fax Number:
619-463-3516
Provider Enumeration Date:
04/08/2010