Provider First Line Business Practice Location Address:
8029 LA MESA BLVD
Provider Second Line Business Practice Location Address:
SUITE 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:
91941-6434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-668-0600
Provider Business Practice Location Address Fax Number:
619-466-2662
Provider Enumeration Date:
12/18/2007