Provider First Line Business Practice Location Address:
7920 BROADWAY
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:
91945-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-378-7758
Provider Business Practice Location Address Fax Number:
619-684-3915
Provider Enumeration Date:
07/09/2019