Provider First Line Business Practice Location Address:
4490 WILLIAMS 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-668-4200
Provider Business Practice Location Address Fax Number:
619-668-4281
Provider Enumeration Date:
10/10/2007