Provider First Line Business Practice Location Address:
5565 GROSSMONT CENTER DR
Provider Second Line Business Practice Location Address:
BUILDING 3, STE. 253
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-461-2900
Provider Business Practice Location Address Fax Number:
619-461-4432
Provider Enumeration Date:
07/18/2006