Provider First Line Business Practice Location Address:
135 E 3RD AVE
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-705-8468
Provider Business Practice Location Address Fax Number:
760-735-2922
Provider Enumeration Date:
02/18/2010