Provider First Line Business Practice Location Address:
3855 AVOCADO BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-7382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-7700
Provider Business Practice Location Address Fax Number:
619-670-3540
Provider Enumeration Date:
07/11/2006