Provider First Line Business Practice Location Address:
120 N ASH ST
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:
92027-3058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-385-3739
Provider Business Practice Location Address Fax Number:
888-800-8266
Provider Enumeration Date:
06/22/2006