Provider First Line Business Practice Location Address:
1830 WEST DR
Provider Second Line Business Practice Location Address:
SUITE 107 NORTH COUNTY VA OUTPATIENT CLINIC
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92083-6125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-643-2089
Provider Business Practice Location Address Fax Number:
760-643-2099
Provider Enumeration Date:
04/26/2006