Provider First Line Business Practice Location Address:
7763 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:
91945-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-464-8391
Provider Business Practice Location Address Fax Number:
619-523-0311
Provider Enumeration Date:
04/01/2007