Provider First Line Business Practice Location Address:
225 E 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-291-6799
Provider Business Practice Location Address Fax Number:
760-291-6949
Provider Enumeration Date:
12/28/2006