Provider First Line Business Practice Location Address:
135 EAST 3RD
Provider Second Line Business Practice Location Address:
#B
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-743-5524
Provider Business Practice Location Address Fax Number:
760-747-5474
Provider Enumeration Date:
09/08/2006