Provider First Line Business Practice Location Address:
135 E THIRD AVE
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:
92025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-745-6264
Provider Business Practice Location Address Fax Number:
760-747-5474
Provider Enumeration Date:
11/08/2006