Provider First Line Business Practice Location Address:
2185 EL PRADO 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:
91945-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-289-0787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2023