Provider First Line Business Practice Location Address:
9000 WAKARUSA ST
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:
91942-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-740-4600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007