Provider First Line Business Practice Location Address:
2009 69TH ST
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:
91945-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-245-7814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2025