Provider First Line Business Practice Location Address:
651 E PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-3053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-743-3135
Provider Business Practice Location Address Fax Number:
760-743-7424
Provider Enumeration Date:
01/12/2006