Provider First Line Business Practice Location Address:
8860 CENTER DR
Provider Second Line Business Practice Location Address:
450
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-460-6200
Provider Business Practice Location Address Fax Number:
619-460-6262
Provider Enumeration Date:
10/03/2006