Provider First Line Business Practice Location Address:
6975 NORTH AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-589-0022
Provider Business Practice Location Address Fax Number:
619-589-0222
Provider Enumeration Date:
05/22/2007