Provider First Line Business Practice Location Address:
8554 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-464-4469
Provider Business Practice Location Address Fax Number:
619-639-0300
Provider Enumeration Date:
09/30/2006