Provider First Line Business Practice Location Address:
5565 GROSSMONT CENTER DR STE 214
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:
91942-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-925-8589
Provider Business Practice Location Address Fax Number:
858-863-5017
Provider Enumeration Date:
05/20/2025