Provider First Line Business Practice Location Address:
8066-68 LA MESA BOULEVARD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-644-9515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2006