Provider First Line Business Practice Location Address:
8875 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:
91941-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-461-2990
Provider Business Practice Location Address Fax Number:
619-461-7959
Provider Enumeration Date:
05/18/2009