Provider First Line Business Practice Location Address:
1001 E GRAND AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-746-2641
Provider Business Practice Location Address Fax Number:
760-740-2178
Provider Enumeration Date:
01/28/2006