Provider First Line Business Practice Location Address:
521 E ALVARADO ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FALLBROOK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92028-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-723-3535
Provider Business Practice Location Address Fax Number:
760-723-7858
Provider Enumeration Date:
06/06/2006