Provider First Line Business Practice Location Address:
2958 CANYON RD
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:
92025-7402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-640-3000
Provider Business Practice Location Address Fax Number:
866-375-1836
Provider Enumeration Date:
07/21/2025