Provider First Line Business Practice Location Address:
240 W MISSION AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-839-3448
Provider Business Practice Location Address Fax Number:
760-839-3405
Provider Enumeration Date:
11/15/2006