Provider First Line Business Practice Location Address:
6818 CENTRAL 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:
91945-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-272-7187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2024