Provider First Line Business Practice Location Address:
3050 MAIN ST
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:
91945-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-463-9931
Provider Business Practice Location Address Fax Number:
619-463-9317
Provider Enumeration Date:
03/29/2013