Provider First Line Business Practice Location Address:
201 E GRAND AVE STE 2A
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:
92025-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-395-2885
Provider Business Practice Location Address Fax Number:
619-393-0390
Provider Enumeration Date:
12/16/2011