Provider First Line Business Practice Location Address:
8030 LA MESA BLVD
Provider Second Line Business Practice Location Address:
#143
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-0335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-697-7900
Provider Business Practice Location Address Fax Number:
619-462-6428
Provider Enumeration Date:
07/28/2005