Provider First Line Business Practice Location Address:
2211 MASSACHUSETTS 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:
91945-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-1331
Provider Business Practice Location Address Fax Number:
619-465-2426
Provider Enumeration Date:
06/12/2006