Provider First Line Business Practice Location Address:
255 N ELM ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-739-5400
Provider Business Practice Location Address Fax Number:
760-739-8440
Provider Enumeration Date:
03/28/2006