Provider First Line Business Practice Location Address:
3280 OLIVE ST
Provider Second Line Business Practice Location Address:
28
Provider Business Practice Location Address City Name:
LEMON GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91945-1767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-0733
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2007