Provider First Line Business Practice Location Address:
8375 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:
91941-3842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-469-2902
Provider Business Practice Location Address Fax Number:
619-469-2114
Provider Enumeration Date:
03/07/2007