Provider First Line Business Practice Location Address:
899 E GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-738-1878
Provider Business Practice Location Address Fax Number:
760-738-9164
Provider Enumeration Date:
05/20/2008