Provider First Line Business Practice Location Address:
463 N MIDWAY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-489-4957
Provider Business Practice Location Address Fax Number:
740-740-1372
Provider Enumeration Date:
12/09/2008