Provider First Line Business Practice Location Address:
7600 PACIFIC 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-717-8990
Provider Business Practice Location Address Fax Number:
619-717-8616
Provider Enumeration Date:
02/12/2015