Provider First Line Business Practice Location Address:
8235 UNIVERSITY AVE
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:
91942-9320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-461-4913
Provider Business Practice Location Address Fax Number:
619-465-5070
Provider Enumeration Date:
11/06/2006