Provider First Line Business Practice Location Address:
250 EAST GRAND AVE
Provider Second Line Business Practice Location Address:
ST B
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-809-9775
Provider Business Practice Location Address Fax Number:
858-605-9606
Provider Enumeration Date:
10/18/2006