Provider First Line Business Practice Location Address:
925 E PENNSYLVANIA AVENUE
Provider Second Line Business Practice Location Address:
SUITE H
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:
760-743-5544
Provider Business Practice Location Address Fax Number:
760-743-5306
Provider Enumeration Date:
05/18/2011