Provider First Line Business Practice Location Address:
10339 ESCONDIDO CANYON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUA DULCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91390-4894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-268-1519
Provider Business Practice Location Address Fax Number:
661-268-1984
Provider Enumeration Date:
04/19/2007