Provider First Line Business Practice Location Address:
254 E GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-489-7841
Provider Business Practice Location Address Fax Number:
760-489-7832
Provider Enumeration Date:
11/03/2005