Provider First Line Business Practice Location Address:
7777 AVARADO RD.
Provider Second Line Business Practice Location Address:
SUITE #255
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-212-5222
Provider Business Practice Location Address Fax Number:
619-328-6856
Provider Enumeration Date:
04/07/2011