Provider First Line Business Practice Location Address:
1111 E WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-745-1511
Provider Business Practice Location Address Fax Number:
760-735-5885
Provider Enumeration Date:
03/29/2006