Provider First Line Business Practice Location Address:
163 N DATE ST
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:
92025-3405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-747-7272
Provider Business Practice Location Address Fax Number:
760-745-3766
Provider Enumeration Date:
10/12/2005