Provider First Line Business Practice Location Address:
8085 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:
91945-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-469-8257
Provider Business Practice Location Address Fax Number:
619-469-2606
Provider Enumeration Date:
08/01/2006