Provider First Line Business Practice Location Address:
1825 S CENTRE CITY PKWY
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:
92025-6525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-738-4236
Provider Business Practice Location Address Fax Number:
760-738-2650
Provider Enumeration Date:
04/19/2016