Provider First Line Business Practice Location Address:
8341 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:
91942-0217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-303-5884
Provider Business Practice Location Address Fax Number:
619-668-2972
Provider Enumeration Date:
04/04/2012