Provider First Line Business Practice Location Address:
488 EAST VALLEY PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-3373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-739-1400
Provider Business Practice Location Address Fax Number:
760-739-1100
Provider Enumeration Date:
11/29/2006