Provider First Line Business Practice Location Address:
7922 PALM 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:
91945-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-464-3488
Provider Business Practice Location Address Fax Number:
619-464-3416
Provider Enumeration Date:
10/25/2006