Provider First Line Business Practice Location Address:
3434 GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMON GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91945-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-889-5718
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2010