Provider First Line Business Practice Location Address:
8764 1/2 GOLDEN RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKESIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92040-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-328-9020
Provider Business Practice Location Address Fax Number:
619-328-9020
Provider Enumeration Date:
09/23/2014