Provider First Line Business Practice Location Address:
7863 LA MESA BLVD
Provider Second Line Business Practice Location Address:
SUITE #102
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-698-9525
Provider Business Practice Location Address Fax Number:
619-698-9546
Provider Enumeration Date:
12/28/2006