Provider First Line Business Practice Location Address:
8130 LA MESA BLVD
Provider Second Line Business Practice Location Address:
NUMBER 140
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-6437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-667-3638
Provider Business Practice Location Address Fax Number:
619-667-3638
Provider Enumeration Date:
07/14/2008