Provider First Line Business Practice Location Address:
8554 CALLE NORTE
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:
91945-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-302-4210
Provider Business Practice Location Address Fax Number:
619-303-4060
Provider Enumeration Date:
04/28/2023