Provider First Line Business Practice Location Address:
7439 BROADWAY
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:
91945-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-464-6419
Provider Business Practice Location Address Fax Number:
619-464-0898
Provider Enumeration Date:
05/22/2007