Provider First Line Business Practice Location Address:
2375 OLD RANCH RD
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:
92027-6733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-703-2874
Provider Business Practice Location Address Fax Number:
760-741-7420
Provider Enumeration Date:
06/19/2013