Provider First Line Business Practice Location Address:
7888 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:
91941-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-460-8211
Provider Business Practice Location Address Fax Number:
619-461-8960
Provider Enumeration Date:
08/31/2006