Provider First Line Business Practice Location Address:
8875 LA MESA BLVD STE C
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:
91942-5434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-668-8100
Provider Business Practice Location Address Fax Number:
619-667-2688
Provider Enumeration Date:
09/18/2007