Provider First Line Business Practice Location Address:
6942 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
#A
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-5963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-698-2184
Provider Business Practice Location Address Fax Number:
619-698-2084
Provider Enumeration Date:
11/14/2005