Provider First Line Business Practice Location Address:
1318 MOUNTAIN PARK PLACE
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:
760-738-8811
Provider Business Practice Location Address Fax Number:
760-738-8886
Provider Enumeration Date:
11/03/2005