Provider First Line Business Practice Location Address:
3231 BUENA VISTA AVE
Provider Second Line Business Practice Location Address:
SUITE # A
Provider Business Practice Location Address City Name:
LEMON GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91945-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-698-1455
Provider Business Practice Location Address Fax Number:
619-460-1743
Provider Enumeration Date:
07/13/2007