Provider First Line Business Practice Location Address:
1882 W EL NORTE PKWY STE C11&C12
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:
92026-3378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-910-1959
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2020