Provider First Line Business Practice Location Address:
2741 LEMON GROVE AVE
Provider Second Line Business Practice Location Address:
#103
Provider Business Practice Location Address City Name:
LEMON GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91945-2975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-713-0258
Provider Business Practice Location Address Fax Number:
619-713-1365
Provider Enumeration Date:
02/28/2007