Provider First Line Business Practice Location Address:
203 E 2ND 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:
92025-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-743-4401
Provider Business Practice Location Address Fax Number:
760-743-7059
Provider Enumeration Date:
02/14/2006