Provider First Line Business Practice Location Address:
705 E OHIO 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:
92025-3418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-489-9490
Provider Business Practice Location Address Fax Number:
760-489-7638
Provider Enumeration Date:
08/13/2006