Provider First Line Business Practice Location Address:
5601 GROSSMONT CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-462-2272
Provider Business Practice Location Address Fax Number:
619-462-2290
Provider Enumeration Date:
11/20/2006