Provider First Line Business Practice Location Address:
8318 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE A5
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-579-2187
Provider Business Practice Location Address Fax Number:
619-579-2187
Provider Enumeration Date:
07/06/2006