Provider First Line Business Practice Location Address:
7872 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:
91941-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-464-1211
Provider Business Practice Location Address Fax Number:
619-464-3211
Provider Enumeration Date:
08/22/2006