Provider First Line Business Practice Location Address:
7484 UNIVERSITY AVENUE
Provider Second Line Business Practice Location Address:
SUITE 310
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-466-3822
Provider Business Practice Location Address Fax Number:
619-466-3822
Provider Enumeration Date:
09/26/2006