Provider First Line Business Practice Location Address:
8875 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:
91942-5434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-8028
Provider Business Practice Location Address Fax Number:
619-670-9675
Provider Enumeration Date:
12/15/2010