Provider First Line Business Practice Location Address:
504 W MISSION AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-747-1980
Provider Business Practice Location Address Fax Number:
760-747-2045
Provider Enumeration Date:
05/24/2005