Provider First Line Business Practice Location Address:
7642 NORTH AVE
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:
91945-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-733-7818
Provider Business Practice Location Address Fax Number:
619-599-8072
Provider Enumeration Date:
01/30/2014