Provider First Line Business Practice Location Address:
150 W CREST ST
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:
92025-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-737-2050
Provider Business Practice Location Address Fax Number:
760-796-3782
Provider Enumeration Date:
01/11/2007