Provider First Line Business Practice Location Address:
2127 E VALLEY PKWY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92027-2775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-741-2813
Provider Business Practice Location Address Fax Number:
760-741-2061
Provider Enumeration Date:
06/30/2006