Provider First Line Business Practice Location Address:
8923 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:
91941-4056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-5252
Provider Business Practice Location Address Fax Number:
619-462-8222
Provider Enumeration Date:
08/30/2006