Provider First Line Business Practice Location Address:
1035 SOUTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLBROOK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92028-3338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-728-2777
Provider Business Practice Location Address Fax Number:
760-728-9732
Provider Enumeration Date:
01/30/2008