Provider First Line Business Practice Location Address:
8600 LA MESA BLVD
Provider Second Line Business Practice Location Address:
ST A
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:
619-465-1990
Provider Business Practice Location Address Fax Number:
619-465-6970
Provider Enumeration Date:
12/01/2006