Provider First Line Business Practice Location Address:
8893 LA MESA BLVD
Provider Second Line Business Practice Location Address:
UNIT (F)
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:
619-466-6890
Provider Business Practice Location Address Fax Number:
619-466-6850
Provider Enumeration Date:
03/11/2024