Provider First Line Business Practice Location Address:
7050 PARKWAY DR
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:
91942-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-542-2253
Provider Business Practice Location Address Fax Number:
619-334-3765
Provider Enumeration Date:
11/30/2023