Provider First Line Business Practice Location Address:
28714 VALLEY CENTER RD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
VALLEY CENTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92082-6554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-500-6253
Provider Business Practice Location Address Fax Number:
760-751-3559
Provider Enumeration Date:
12/27/2006