Provider First Line Business Practice Location Address:
425 N DATE 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:
92025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-517-2252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2007