Provider First Line Business Practice Location Address:
VISTA DETENTION FACILITY
Provider Second Line Business Practice Location Address:
325 SOUTH MELROSE DRIVE #200
Provider Business Practice Location Address City Name:
VISTAA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-940-4803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2016