Provider First Line Business Practice Location Address:
2051 WASHINGTON 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:
91945-4268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-743-3387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2025