Provider First Line Business Practice Location Address:
7777 ALVARADO ROAD
Provider Second Line Business Practice Location Address:
SUITE 408A
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-460-4322
Provider Business Practice Location Address Fax Number:
619-460-4312
Provider Enumeration Date:
02/21/2007