Provider First Line Business Practice Location Address:
7366 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE C & D
Provider Business Practice Location Address City Name:
LEMON GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91945-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-466-0806
Provider Business Practice Location Address Fax Number:
619-466-5012
Provider Enumeration Date:
09/27/2006