Provider First Line Business Practice Location Address:
8001 PALM 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:
91945-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-258-4012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2008