Provider First Line Business Practice Location Address:
8130 PARKWAY DRIVE
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:
91942-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-474-4072
Provider Business Practice Location Address Fax Number:
619-414-4080
Provider Enumeration Date:
05/28/2009