Provider First Line Business Practice Location Address:
310 S BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-745-4451
Provider Business Practice Location Address Fax Number:
760-735-2425
Provider Enumeration Date:
01/23/2007