Provider First Line Business Practice Location Address:
324 S KALMIA STREET
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:
760-741-7497
Provider Business Practice Location Address Fax Number:
760-741-7729
Provider Enumeration Date:
06/16/2005