Provider First Line Business Practice Location Address:
8685 LA MESA BLVD
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:
91941-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-466-6825
Provider Business Practice Location Address Fax Number:
619-462-9239
Provider Enumeration Date:
05/14/2008