Provider First Line Business Practice Location Address:
463 N MIDWAY
Provider Second Line Business Practice Location Address:
STE 200
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:
760-740-1372
Provider Business Practice Location Address Fax Number:
760-489-4811
Provider Enumeration Date:
09/12/2008