Provider First Line Business Practice Location Address:
8077 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:
91942-6434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-8077
Provider Business Practice Location Address Fax Number:
619-463-4943
Provider Enumeration Date:
01/08/2008